Child Well-Being: A Systematic Review of the Literature

Author(s): Elizabeth L. Pollard and Patrice D. Lee

Source: Social Indicators Research, Vol. 61, No. 1 (Jan., 2003), pp. 59-78
Published by: Springer
Stable URL: http://www.jstor.org/stable/27527061 .
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 ELIZABETH L. POLLARD and PATRICE D. LEE

CHILD WELL-BEING:
A SYSTEMATICREVIEWOF THELITERATURE

(Accepted 2 April 2002)

ABSTRACT. A systematic review the child well-being literature in English was

conducted with searches in five databases to assess the current state of child well
being research and answer the following questions: (1) How is child well-being
defined? (2) What are the domains of child well-being? (3)What are the indic
ators of child well-being? and (4) How is child well-being measured? This review
updates and expands a previous review of the child well-being literature spanning
1974-1992. Results indicate that well-being is a commonly used but inconsist
ently defined term frequently included in the study of child development. There
are five distinct domains of child well-being: physical, psychological, cognitive,
social, and economic. Positive indicators are used more often in the physical,
cognitive, social, and economic domains, while more negative or deficit indicators
are used in the psychological domain. There is little agreement in the research
literature on how to best measure child well-being.

INTRODUCTION

The study of well-being is a significant emerging frontier in child

development research. There is increasing demand for research that
extends beyond the study of children's disorders, deficits, and disab
ilities. Now is the time to place emphasis on the positive attributes
of children. By examining children's strengths, assets, and abilities,
the determinants of a positive developmental trajectory can be estab
lished. Only by examining children's strengths and abilities will
we discover the core elements of well-being that enable children
to flourish and thrive.
The child well-being literature base is enormous and continues to
expand rapidly. To the extent that this reflects ongoing research and

potential advances for the promotion of well-being in children, this

expansion is very promising. At the same time, however, it makes
the task of locating the best and most useful information on child

Social Indicators Research 61: 59-78,2003.

* ? 2003 Kluwer Academic Publishers. Printed in the Netherlands.

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60 ELIZABETHL. POLLARDAND PATRICED. LEE

well-being more challenging. Given the gaps and unanswered ques

tions that exist in the research base on child well-being, a systematic
review is needed to assess the current state of child well-being
research.
A systematic review of the English language child well-being
literature spanning 1974-1992 (Toles et al., 1993) summarized the
child well-being research base. This review updates and expands on
that review to assess the current state of the English language child
well-being research.

METHODOLOGY

This review focuses on the 1991 to 1999 child well-being literature.

Its purposes are: (1) to examine the definitions of child well-being;
(2) to examine the indicators of child well-being; and (3) to examine
the instruments used to measure the indicators of child well-being,
thus contributing to a more integrated understanding of the state of
the research base.
This
systematic review of the child well-being research base
updates and expands the Toles et al. (1993) review. Both reviews
used a three-phase methodology: a key term search, a title screen

review, and a content screen review. We replicated this methodology

to facilitate comparing our findings with those of the 1972-1992
review. One significant variation in the more current review is the
inclusion of studies of children living in developing countries. Our
search strategy identified articles that studied children from thirty
one different countries around the world. Of these articles, thirteen
studied children from developing countries.
In applying this methodology, several challenges became
apparent. First, of the articles on child well-being included in this
review, almost half (47%) included deficit indicators of child well
being. Second, multiple definitions, indicators, and measures of

well-being are used. We must empirically define well-being and

ascertain the scope of what well-being encompasses. Finally, the

well-being literature base spans a variety of disciplines and exam

ines well-being in a myriad of ways. Well-being is a complex, multi
faceted construct that has continued to elude researchers' attempts

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 CHILDWELL-BEING 61

TABLE I
Database Search Results

Database

PsychINFO Socio- ERIC MEDLINE HealthSTAR Total

(1990-99) logical (1990-99) (1990-99) (1991-99) (1990
abstracts 99)

Citations of key terms, per database

Quality of life 97 225 73 317 14

737
Life satisfaction 46 84 34 ? 164?
Well-being 230 38 146 209 632 9
Wellness 9 51 63 9 1364

Total 382 398 316 535 27 1658

Note. Duplicate articles arising from the same article appearing in multiple
databases are included in the total number.

to define and measure it. Reviewing the research base on well-being

is therefore difficult.

DATABASE SEARCHES

The updated review searched five computer databases: PsychINFO,

Sociological Abstracts, ERIC, MEDLINE and HealthSTAR. The
databases were searched on-line using the OVID and Galileo search

engines. The searches also included key terms to limit the search
to humans in the age range birth to eighteen years. Following this
algorithm, 1,658 articles were identified. A summary of the key
terms and the yields is presented in Table I.

Title Screen Review

Two raters independently screened the 1 658 citations obtained
from the computerized database searches. The articles were sorted
into relevant and non-relevant sets based on a title screen review.
After screening the titles, the total number of relevant citations was
415. These citations did not include articles pertaining to clinical
populations since all articles containing cancer, tumor, transplant,
transplantation, syndrome, or disease in the title were excluded.

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 62 ELIZABETHL. POLLARDAND PATRICED. LEE

Articles were included if their titles contained any of the following

terms: well-being or Wellness, quality of life, life satisfaction, satis
faction with life, self-esteem, health, or In addition,
happiness.
articles had to contain one of the following terms in the title: child
(or synonym), adolescent (or synonym), student (or synonym), p?di
atrie, or measure, measures, measuring, correlates, determinants,
instrument, scale, or index.
The two raters agreed on the inclusion of all but ten articles.
Five articles contained synonyms for measure. These terms
included "schedule", "questionnaire", and "assessment". One article
contained the term "undergraduate", considered to be a synonym for
student. Both raters agreed to include the aforementioned articles.
The raters initially disagreed as to whether "obesity" should be
excluded as a syndrome; however, after discussion, they agreed to
include it. Lastly, three articles were included in the original search
because they contained key terms within parentheses after the title.
Both raters agreed to exclude these citations, as the word in paren
theses were considered not part of the title. In sum, seven of the ten
articles were included and three were excluded.

Content Screen Review

The remaining 415 citations were then screened using the exclu
sion criteria presented in Table II (Toles et al., 1993). As a result
of this process, 240 citations were excluded. The second rater then
screened a random 10% of these articles and found that both raters
agreed on all except one article on "family life satisfaction". After
discussion, they decided to include this article.

RESULTS

The results of the title and content screen are illustrated in Table III.

DEFINITIONS

Well-being is a term that is commonly used but inconsistently

defined in the study of child development. A systematic review of
the child well-being literature reveals that the definition of well
being is highly variable. Well-being has been studied across a wide

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 CHILDWELL-BEING 63

TABLEn
Content Screen Exclusion Criteria

Focus is a clinical condition.

The sample does not include a general or community population.
Focus is well-being of parents.

Sample has mean age of greater than 18 years; if the sample included children
and adolescents, there is no specific analysis of them as a subgroup.

Focus is fetal or neonatal well-being.

Purpose is debate of ethical issue (e.g., Baby Doe).

Focus ismortality issue.
No references are cited.

TABLE IH
Title and Content Screen Results

Database Years Results of Results after Results after Inter-rater

searched search title screen content screen reliability
N N Cohen's
(%of total) (%of total) Kappa

PsychlNFO 1990-99 382 164(39.5%) 122 (46.2%) 0.995

Sociological 1990-99 398 88 (21.2%) 43 (16.3%) 0.949
abstracts

ERIC 1990-99 316 93(22.4%) 49(18.6%) 1.000

MEDLINE 1991-99 535 63 (15.2%) 45 (17.0%) 0.981
HealthSTAR 1990-99 27 7(1.7%) 5 (1.9%) 1.000
Combined 1,658 415(100.0%) 264a (100.0%) 0.980
database results

Note. There are 89 duplicates included in this value (264a). Final number of
citations after content screen =175.

range of disciplines, age groups, cultures, communities and coun

tries, resulting in an assortment of definitions. Unfortunately, the

great variability among definitions and indicators of well-being

hampers efforts to compare findings across studies.

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64 ELIZABETHL. POLLARDAND PATRICED. LEE

Well-being has been defined by individual characteristics of an

inherently positive state (happiness). It has also been defined on
a continuum from positive to negative, such as how one might
measure self-esteem. Well-being can also be defined in terms of
one's context (standard of living), absence of well-being (depres
sion), or in a collective manner (shared understanding).
A consistent, unified definition of well-being is needed. To
further this end, well-being could be defined and operationalized
at the individual level within a specific domain (physical, social,
cognitive, or psychological) or at the environmental level by incor

porating effects of the developing child's environmental context. A

more useful definition of well-being would be one that is similar
to the one adopted by Yarcheski, Scoloveno, and Mahon (1994).
Yarcheski et al. used Columbo's (1986) conceptualization of adoles
cent well-being, which described well-being as "a multidimensional
construct incorporating mental/psychological, physical, and social
dimensions" (p. 288). This type of consistent approach leads to
a more comprehensive definition spanning multiple domains and
influences. In our review, we found five similar definitions presented
in Table TV.

THE DOMAINS AND INDICATORS OF CHILD WELL-BEING

The literature reviewed resulted in the identification of five distinct

domains of well-being physical, psychological, cognitive, social,
and economic. The social domain includes only sociological
perspectives. Psychosocial perspectives fall within the psycholo
gical domain. The psychological domain includes indicators that
pertain to emotions, mental health, or mental illness, while the

cognitive domain includes those indicators that are considered intel

lectual or school-related in nature. Indicators for each domain
were divided into negative and positive clusters (see Appendix).
Negative or deficit indicators
represent a one-dimensional negative
state, such as anxiety or depression. Positive indicators comprise
elements of a one-dimensional positive state, such as happiness,
and those on a continuum, such as self-esteem (Toles et al., 1993).
Table V summarizes the number of negative and positive well-being
indicators studied within a domain for each age group.

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 CHILDWELL-BEING 65

TABLE TV
Definitions of Well-being

Author Definition of Well-being

Columbo, S.A. (1986) "A multidimensional construct incorporating mental/

psychological, physical, and social dimensions", as
cited in Yarcheski et al. (1994: p. 288).
Weisner, T.S. (1998) "The ability to successfully, resiliently, and innovat
ively participate in the routines and activities deemed
significant by a cultural community. Well-being is
also the states of mind and feeling produced by
participation in routines and activities" (pp. 75-76).
Schor,E.L.(1995) "Children's health and well-being is directly related
to their families' ability to provide their essential
physical, emotional, and social needs" (p. 413).
Keith, K.D. and R.L. "General view of the person's feelings regarding
Schalock(1994) his/her life circumstances, including personal prob
lems and some questions about family" (p. 84).
Martinez, R.O. and R.L. "As self-esteem, purpose in life, and self-concept of
Dukes (1997) academic ability (self-confidence)" (p. 504).

Although a wide variety of indicators have been investigated,

some common themes were noted. In general, there are a greater
number of indicators used to study older children. The physical,
cognitive, economic, and social domains tend to measure more

positive indicators of well-being, while the psychological domain

relies more heavily on deficit indicators. The psychological domain
has the largest total number of indicators and is the only domain
where more deficit than positive indicators have been studied. Reli
ance on negative or deficit indicators of well-being fails to capture
the positive continuum of the strengths, assets, and abilities that can
be promoted in children and adolescents. For example, in one study,
stress and depression were the sole indicators of adolescent well

being (McFarlane et al., 1995). Well-being is, of course, more than

the absence of stress and depression. However, a core set of positive
indicators of child well-being has not yet been determined.

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66 ELIZABETHL. POLLARDAND PATRICED. LEE

TABLEV

Summary ofWell-being Indicators by Domain, Status and Age Group

Domain

Cognitive Economic Physical Psychological Social Total

Child*
Deficit 3 0 25 3 35
Positive 4 1 21 7 41
Pre-adolescenft
Deficit 3 1 4 41 4 53
Positive 6 1 7 30 12 56
Adolescenf
Deficit 4 0 4 40 3 51
Positive 7 1 6 36 12 62
Total 27 33 193 41 298
aChild includes ages 2 to 10 years.
bPre-adolescent includes ages 8 to 13 years.
c
Adolescent includes ages 11 to 19 years.

MEASURING CHILD WELL-BEING

There is little agreement in the research literature on how to

best measure child well-being. Well-being was assessed using
structured and non-structured interviews, standardized tests, and

single-item questions from national data sets. Objective measures

of child well-being ranged from reviews of individual child case
histories, educational assessments, and medical records to infant
death rates, national statistics on delinquency and suicide attempts,
and drug offense rates. Subjective measurement of well-being typic
ally consisted of one of the following approaches: one-dimensional
measures, multidimensional
single scale measures, or the use of

multiple separate measures. For each age group, there were more

subjective measures than objective measures. For children, there

were 137 subjective measures and 36 objective measures, for pr?
adolescents, there were 220 subjective measures and 36 objective
measures, and for adolescents, there were 245 subjective measures
and 34 objective measures.

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 CHILDWELL-BEING 67

As the most common approach to the measurement of well

being, the use of multiple separate measures involves the assessment

of presumed indicators of well-being such as self-esteem, depres
sion, or relationships. Thisapproach, while prevalent, has significant
limitations. Studies that use a few scales to measure indicators of

well-being in one or two domains miss the other dimensions. Thus,

these studies may not actually measure well-being because they do
not include important domains of well-being.
Positive and negative indicators of well-being, such as self
esteem and
depression, are commonly measured to assess overall

well-being. However, well-being is more than a sole indicator in a

single domain. In order to accurately measure well-being, it is crit

ical that the measurement tool used captures the multi-dimensional
nature.

Measurement of well-being frequently diverges from the multi

dimensional nature of the construct. Researchers often report that

they are measuring a child's well-being when in fact they are

assessing a single domain or indicator of well-being, not recog

nizing they are merely assessing an aspect of well-being. The
studies included in this review were mostly categorical with 80.0
percent measuring only a single
domain, percent 13.1 measuring
two domains, and 4.6 percent measuring three domains. Only four
articles included in this review, or 2.3 percent, assessed child well

being in the cognitive, physical, psychological, and social domains

(Ajdukovic and Ajdukovic, 1993; Evans et al., 1998; Househnecht
and Sastry, 1996; McCormick et al., 1996).
For each domain, measures assessed presumed negative and

positive indicators of well-being. For instance, instruments used

to assess well-being by measuring positive indicators within the

psychological domain include the Rosenberg Self-Esteem Scale

(Rosenberg, 1965) and the Purpose in Life Scale (Crumbaugh,
1968). Examples of instruments measuring deficit indicators within
the psychological domain include depression and anxiety meas
ures, such as the Child Depression Inventory (Kovacs, 1981), the
State-Trait Anxiety Inventory (Spielberger, 1983), and the Hospital
Anxiety and Depression Scale (Zigmond and Snaith, 1983). Some
measures, such as the Affect Balance Scale (Bradburn, 1969) and
theGeneral Weil-Being Scale (Andrews andWhitney, 1976), identi

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68 ELIZABETHL. POLLARDAND PATRICED. LEE

fied a balance between the positive and negative psychological state

to assess well-being.
Measures in the social domain assessed family and peer relation

ships, the availability of emotional and practical support, personal

resources, socially desirable behaviors, and interpersonal, and
communication skills. In the cognitive domain, assessment focused

primarily on academic achievement and intelligence tests; however,

measures of creativity, memory, classroom behavior, perceived
competence in academic ability, and whether or not the child or
adolescent was satisfied with or liked school were also identified.
Instruments in this domain also included measures that assessed

parents, school counselors, and teachers' perception of children's

academic performance.
The economic and physical domains had the fewest number of
instruments. Economic measures included assessments family of
resources, adequacy of parental income, and economic hardship.
These measures were primarily used in determining government
assistance and child support. Measures in the physical domain
assessed physical health. These measures included physical exam
inations, assessments of participation in physical activities, Wellness

knowledge, and eating attitudes. Negative health behaviors were

also assessed in some instances in which the study examined
variables of risk behavior, such as smoking and drug use.
There is no standard method to assess well-being in children. The
majority of authors used multiple separate measures of presumed
indicators of well-being in an effort to capture a more complete
assessment of the state of the child's Some studies
well-being.
examined well-being using only instruments that measured deficit
indicators such as depression and anxiety, while others used meas
ures of only positive indicators such as self-esteem and life satis
faction. Some used a combination of the two. A child's well-being
cannot be assessed or not the
accurately by examining only whether
child exhibits a particular "mood" or "feeling". Assessing specific
indicators such as depression or self-esteem reflects a facet of the
child's psychological well-being and not well-being in its entirety.
In conclusion, a voluminous number of instruments are currently

being used to assess child well-being. Many of these instruments

were not designed to measure as a construct but rather
well-being

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 CHILDWELL-BEING 69

measure specific indicators of well-being. Using these measures,

researchers have equated either the presence or absence of a specific

presumed indicator to "well-being". Further research needs to be

done in the area of defining and measuring well-being as a construct.
The development of a multi-domain instrument, which captures
both subjective and objective data using an ecological approach in
examining the child's performance, would be most useful. Table VI
illustrates a sampling of instruments that have been used to assess

well-being.

CONCLUSIONS

Inconsistent use of definitions, indicators, and measures of well

being has created a confusing and contradictory research base.

Findings from this review point to significant gaps in the child well
being literature and suggest future directions for research. Currently,
studies on well-being frequently employ "bait and switch" tactics:
well-being is in the title of the article yet, upon further inspection,
well-being is measured in only a single domain or with primarily
deficit indicators. Inconsistencies in defining well-being were not
the only limitations identified in prior studies. Much of the research
base is correlational in nature, which does not allow for an exam
ination of direction of effects. Other studies measure well-being
inconsistently.
Well-being is often framed within a model of child deficits
rather than a model of child strengths. This emphasis might lead
researchers, policymakers, and practitioners to focus research and
intervention efforts on children's deficits and discount the potential
to identify and promote children's strengths.
Several limitations of this study should be noted. Although
the systematic search strategy was thorough, limiting the key
words searched restricted the scope of the literature retrieved. A
second potential limitation is the exclusion of non-journal articles,
precluding gleaning information from unpublished literature.

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 TABLEVI
Well-being Instruments

Instrument Description Indicator Domain

Perceived Competence Designed tomeasure Cognitive compet Physical,

Scale for Children children's perceptions ence, peer relation social,

(Harter, 1982) of their competence and ships, scholastic psychological,

self-adequacy performance, phys and Cognitive
ical skills/compet
ence, & global self
worth
Multidimensional Assesses children's Life satisfaction Psychological
Students' Life Satisfac subjective perceptions and social
tion Scale of life satisfaction in
(Huebner, 1994) five conceptually rele
vant domains.

Cognitive Abilities Test Designed to assess the Reasoning and Cognitive

(Thorndike and Hagen, development of cogni problem-solving
1986) tive abilities related to
non-verbal, quantita
tive, and verbal reason

ing and problem

solving skills

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 TABLEVI
Continued

Instrument Description Indicator Domain

20-item scale designed Family cohesion and Social

Family Adaptability
and Cohesion Scales to assess family func family adaptability
(FACESIII) tioning
(Olson et al., 1985)
B attelle Developmental Designed to be used as Self-concept, affect, Social,
Inventory Screening a tool for screening, coping, adult interac psychological,
Test diagnosis, and evalu tion, peer interaction, physical, and
(Newborg et al, 1988) ation of early develop social role, personal cognitive
ment responsibility, eating,
dressing, attention,

toileting, receptive
and com
expressive
munication, acade

mic skills, memory,

reasoning, cognitive
development, per

ceptual motor, loco

motion, muscle con

trol, and coor

body
dination.

*Note. Test-retest reliability.

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72 ELIZABETHL. POLLARDAND PATRICED. LEE

FUTURE DIRECTIONS

The future child well-being research agenda can be built upon what
has been learned. A logical next step is to develop a set of core
positive indicators of child well-being in each domain in conjunc
tion with a set of instruments thatmeasure them. Such work would
yield important contributions to the conceptualization and measure
ment of child well-being and, ultimately, improve the practice of
promoting the well-being of children.

APPENDIX

Indicators by Domain and Age Groupa

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Cognitive (negative)
Academic incompetence
Concentration *

Developmental delay *
School Behavior problems *

Cognitive (positive)
Academic achievement *

Cognitive ability *

Quality of school life

School function *
School integration *
School-related behaviors *

Self-concept of academic ability *

Economic (negative)
Child support

Economic (positive)
Child support

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 CHILDWELL-BEING 73

Continued

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Physical (negative)
Health compromising behaviors *

Physical abuse *
Physical manifestations of stress *

Physical symptoms of illness *

Substance abuse

Substance use

Physical (positive)
Exercise *
Full immunization coverage *
Health promoting behavior *
Nutrition *
Personal body care *

Physical appearance *

Physical health *

Safety-related behavior *

Well-being

Psychological (negative)
Adjustment problems *

Aggression *

Anger *

Anxiety *
Behavior problems *

Delinquency
Depression *

Despondency *
Deviant behaviors *
Distress

Eating-related behavior problems

Emotional problems *

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Continued

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Externalizing behaviors * **
Fearfulness * * *

Fears of future *
General psychological distress *
Health compromising behaviors * *

Hopelessness * *

Hyperactivity * * *

Impaired concentration * *
Inattention *

Internalizing behaviors * **

Irritability * *
Loneliness * *

Maladjustment *

Negative affect * *
Nervousness * *

Neuroticism *
* * *
Nightmares

Non-psychiatric disturbances * *
Panic * *

Psychiatric symptoms * **

Psychological distress * * *

Psychological health symptoms *

Recurrent memories of bullying * *
Self-centeredness *

Self-inflicted injury * * *

Spitefulness * * *
Stress * * *

Suicidal ideation/attempts * *
* * *
Weeping

Whining * *

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 CHILDWELL-BEING 75

Continued

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Withdrawal

Psychological (positive)
Adjustment * *
Attachment * *

Autonomy *
Behavioral competence
Behavioral functioning *

Capacity to love *
Cheerfulness

Competence * *

Coping * *
Emotional adjustment * *
Emotional support * *

Expansiveness
*
for success *
Expectancy
Fulfillment *
Global satisfaction *
Global self-worth *

Happiness *

Hopefulness *
Initiative *
Life satisfaction *

Mastery *
Mental health *
Overall functioning *
Positive affect *
Positive attitude toward school *
Positive attitude toward self *
Positive mood

Purpose in life

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76 ELIZABETHL. POLLARDAND PATRICED. LEE

Continued

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Resilience * *
Satisfaction with gender * *
Satisfaction with self * *

Self-concept
* *
Self-esteem * *
Self-identified strengths *
Self-reliance *
Self-satisfaction
Self-worth *
Socio-emotional adjustment *
Stress management

Well-being

Social (negative)
Anti-social behavior

Negative life events

Peer problems *

Poverty *
Troubled home relationships *

Social (positive)
Family relations *
Parent-child relations * *

Participation in cultural activities * *

Prosocial behaviors * *
Prosocial values * *

Quality of life * *

Relationships in the home * *

Relationships in the school * *

Relationships with peers * *

Social acceptance *

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 CHILDWELL-BEING 77

Continued

Domain (status) indicators Age group

Child Pre-adolescent Adolescent

Social skills * *
Social * *
support

Socioeconomic status *

Well-being *

Note. *the symbol under age group indicates the indicator was found
in the literature. aAge group: Child includes ages 2 to 10 years; Pre
adolescent includes ages 8 to 13 years; Adolescent includes ages 11 to
19 years.

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Center for Child Well-being

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