Promoting Resilience with Social-Emotional Learning: Young Adult Follow-up of a Preschool Randomized-Controlled Trial

Abstract

Young adults are experiencing emotional distress at unprecedented levels, with rates of loneliness, social isolation, and poor mental health especially high among those marginalized by economic hardship. Individuals who experience exposure to adverse experiences during childhood face heightened vulnerability, indicating a need to enhance early developmental supports. Public investment in early childhood education provides a unique opportunity to strengthen social-emotional supports for children at socioeconomic risk. This longitudinal study evaluated the impact of enriching Head Start classrooms with intensive support for social-emotional learning (SEL) and language development on the young adult well-being of children growing up in low-income families. A randomized-controlled trial including 356 children (25% Black, 17% Latinx, 58% White, 54% female, 46% male, Mage = 4.49 years at study entry) evaluated the effects of enriched relative to “usual practice” Head Start; follow-up assessments extended through early adulthood (age 21–22 years). Significant benefits favoring the intervention group emerged on 7 of 11 measures of young adult well-being, including conduct problems, depressive symptoms, loneliness, empathy, emotional support, healthy days, and overall life satisfaction. Latent profile analyses showed the preschool intervention increased the likelihood of displaying a profile reflecting higher (rather than lower) young adult well-being. Greater exposure to adverse childhood experiences (ACEs) predicted diminished adult well-being but intervention buffered the impact of ACEs on social adjustment. Findings suggest that enriching preschool with intensive evidence-based SEL and language support can leverage public investments in early education and enhance the long-term well-being of vulnerable children growing up in poverty.

Introduction

Young adults in the United States are experiencing unprecedented levels of emotional distress with negative impact on their health and well-being (American Psychological Association [APA], 2025; Udupa et al., 2023). More than half of the respondents to a recent APA survey reported heightened levels of social isolation, depression, anxiety, insufficient emotional support, and impairment in daily functioning (APA, 2025). These findings, consistent with other national surveys (Udupa et al., 2023), reflect ongoing declines in young adult mental health and well-being that began prior to the pandemic, were exacerbated during it, and now represent an urgent public health concern (Anderson et al., 2025). These trends underscore the need to look beyond treatment access alone and consider preventive strategies that address the developmental origins of young adult well-being.

Increasingly, young adult well-being is understood to encompass not only mental health symptoms, but also social connectedness, emotional support, and subjective quality of life (Hawkins et al., 2009; VanderWeele & Johnson, 2025). Multiple factors likely contribute to recent declines in young adult well-being, including increased social media engagement, elevated economic hardship, reduced social support from extended families and communities, and growing sociopolitical uncertainty (Anderson et al., 2025; APA, 2025). Growing up in poverty more than doubles the risk of developing mental health difficulties (Peverill et al., 2021), contributing to disparities in young adult well-being that were further exacerbated by the recent pandemic (Fortuna et al., 2023). Individuals exposed to chronic stress and adversity during childhood are particularly vulnerable to experiencing emotional distress as they transition into adulthood (AEI/Brookings Working Group on Poverty and Opportunity, 2015).

The negative impact of socioeconomic disadvantage on early development has been attributed to limited financial resources and lower levels of parental education, which contribute to chronic stressors such as food and housing insecurity, undesirable living conditions, and under-employment (Duncan et al., 2019). These stressors can undermine parent well-being and increase the likelihood of family dysfunction (Evans & De France, 2022). Socioeconomic disadvantage also increases risk of adverse childhood experiences (ACEs) including family instability, parent-child separation, family conflict, unpredictable or harsh parenting, and parent depression (Evans & De France, 2022). These early childhood experiences may hinder the development of social-emotional and language skills that support adaptive coping, thereby amplifying distress in response to later life challenges (Yoshikawa et al., 2012). The effects of ACEs are often long-lasting, contributing to academic underachievement, social and behavioral maladjustment, and heightened levels of mental health distress in adolescence and early adulthood (Walsh et al., 2019).

Researchers and policymakers alike have identified early preventive interventions as one important strategy for reducing the negative developmental impact of economic hardship and associated social marginalization (AEI/Brookings Working Group on Poverty and Opportunity, 2015). Public investment in early childhood education (ECE) in the U.S. (via Head Start and public pre-K) facilitates the delivery of developmental supports for young children and their parents affected by socioeconomic disadvantage (Hahn & Barnett, 2023). In addition to promoting child school readiness and reducing the socioeconomic gap in educational attainment, publicly-supported ECE aims to improve the health and mental health of recipients, reduce their need for social services, and strengthen their future workforce readiness (U.S. Congress, Joint Economic Committee, 2024). Publicly funded ECE programs are uniquely positioned to serve as scalable preventive platforms because they reach children during sensitive developmental periods before maladaptive trajectories become entrenched.

Long-term Effects of Preschool Programs

Three important model programs initiated prior to 1985 (Perry Preschool, Abecedarian Project, and Chicago Parent-Child Centers) produced compelling evidence that ECE can promote significant benefits lasting into adulthood (Burchinal, 2023). Since that time, public support and funding for ECE has risen dramatically, with a majority of U.S. preschool-aged children now attending center-based ECE programs (Burchinal, 2023). Accordingly, contemporary preschool program research has shifted focus to comparative studies designed to illuminate the relative benefits of different preschool program elements or approaches (Whitaker et al., 2023). Accumulating research on contemporary preschool programming has produced variable findings, generating concerns about the magnitude of effects and the fade out of preschool benefits over time, which often become non-significant after elementary school entry (Bailey et al., 2020; Whitaker et al., 2023). Recent research reviews emphasize the need for more rigorous research to illuminate the features of ECE programs that hold the most promise for promoting sustained benefits for children from disadvantaged backgrounds (Burchinal et al., 2024).

One promising approach involves the use of systematic and explicit social and emotional learning (SEL) programs in preschool classrooms (Blewitt et al., 2018; Luo et al., 2020; Murano et al., 2020). These are programs that include well-specified and developmentally sequenced lesson plans and aligned teaching strategies designed to promote growth in social and emotional competencies, including prosocial behavior, emotional understanding, self-regulation, and social problem-solving skills (Blewitt et al., 2018; Murano et al., 2020). Conceptually, gains in these skills during the preschool years may sustain over time because they support effective classroom participation and relationship-building when children enter formal schooling, promoting positive school and social experiences that, in turn, support their subsequent social and emotional growth and well-being (Abenavoli, 2019; Bailey et al., 2020; Burchinal, 2023; Pages et al., 2023). Mediation analyses have linked early gains in social and emotional skills to the long-term benefits produced by the Child-Parent Center program (Reynolds & Ou, 2011). More recently, longitudinal follow-up of participants in the randomized controlled trial of a preschool SEL enrichment program (the Chicago School Readiness Program) documented early adolescent benefits in executive functioning and self-reported academic performance (Watts et al., 2023).

Variation in Preschool Program Impact

Another contemporary research question is whether children benefit differentially from preschool program enrichments depending on their early life experiences (Morris et al., 2018). Studies of heterogeneity in preschool intervention effects often find that children from socioeconomically disadvantaged backgrounds benefit the most, possibly because high-quality ECE offsets the limited access to early learning resources associated with poverty (Cooper & Lanza, 2014; Morris et al., 2018; Yoshikawa et al., 2012).

Exposure to early ACEs may also affect children’s response to preschool programming (Scott et al., 2021). ACEs exacerbate the emotional distress associated with economic disadvantage by reducing access to sensitive and responsive caregiving, and exposing children to chronic stress and unpredictable threat, fueling elevations in emotion dysregulation, challenging behaviors, and social difficulties (Hawes & Allen, 2023). Conceptually, the negative developmental impact of ACEs occurs when the accumulation of stressors reaches a threshold that overwhelms the coping capacities of child and family and disrupts adaptive stress responding (Evans & DeFrance, 2022; Oldfield et al., 2015). Correspondingly, researchers have documented a disproportionate increase in maladjustment among individuals exposed to high levels of ACEs (Giovanelli et al., 2020; Oldfield et al., 2015) and threshold effects have emerged in studies examining ACEs as a moderator of intervention effects (Tabone et al., 2022). Children exposed to multiple ACEs often enter preschool with elevated social and emotional needs.

Supporting SEL and language skills during preschool may increase resilience in the face of high ACEs by strengthening child capacities to establish positive supportive relationships with others, more effectively regulate their emotions and behaviors, and engage in adaptive problem solving when faced with interpersonal challenges (Osher, 2021; Scott et al., 2021). However, some studies report weaker intervention responses among individuals with high ACE exposure, potentially due to higher rates of comorbid psychopathology (Edinger et al., 2020). For example, a recent study found that benefits from a community-based trauma intervention were limited to those exposed to six or fewer ACEs (Tabone et al., 2022). Further research is needed to examine whether high ACE exposure moderates children’s response to preschool SEL programming.

The Present Study

The primary aim of the present study was to evaluate the long-term impact of adding an intensive SEL program with integrated support for language development into Head Start preschools on young adult well-being. The intervention, the Head Start Research-based, Developmentally Informed (REDI) program sought to promote preschool growth in foundational social and emotional competencies and language skills in ways that might buffer the negative impact of early adversity exposure and promote positive developmental cascades contributing to enhanced well-being in later life (Murano et al., 2020). The foundation of REDI was a classroom SEL program, the Preschool PATHS Curriculum, which promotes growth in prosocial behavior, emotional understanding, self-regulation, and social problem-solving skills (Domitrovich et al., 2007). REDI added a daily interactive reading program that used books aligned with the PATHS social and emotional themes, designed to intensify SEL exposure and strengthen child oral language skills, along with curriculum components designed to build phonological awareness and print concepts (Gest et al., 2015). REDI provided teachers with professional development support to enhance their implementation of program activities and teaching strategies, and parents received materials illustrating REDI interaction strategies and suggesting aligned home learning activities.

Compared with children attending Head Start classrooms randomized to continue their usual practices (control group), children in Head Start classrooms using the REDI enrichments showed greater gains in child language and literacy skills (vocabulary, print knowledge, phonemic awareness) and social and emotional competencies (emotion knowledge, social competence, social problem-solving skills, reduced aggression) at the end of preschool (Bierman et al., 2008). Longitudinal follow-up analyses revealed the early elementary school fade out of initial gains in the language and literacy domain (Bierman et al., 2014) but sustained benefits through high school in the social and emotional domain, reflected in significant reductions in high school externalizing behavior problems and emotional distress (Bierman et al., 2025). Longitudinal mediation analyses were consistent with hypothesized developmental cascade models, as REDI intervention effects on high school behavioral and emotional adjustment were mediated by earlier REDI boosts to children’s preschool emotional understanding and social competence, and their gradeschool social adjustment, positive relationships with peers and teachers, and positive parent-teacher involvement (Bierman et al., 2025).

This study extends the longitudinal timeframe of the follow-up assessments. The primary aim was to evaluate the long-term impact of the REDI preschool intervention on young adult well-being, assessed holistically as a multi-component profile representing the inter-dependent dynamics of mental health symptoms, social connectedness, and quality of life (Hawkins et al., 2009; VanderWeele & Johnson, 2025). Additional exploratory analyses examined the impact of REDI on the individual component measures representing young adult well-being, evaluated associations between exposure to high levels of early ACEs and diminished young adult well-being, and considered whether early ACEs exposure moderated REDI effects.

Method

Procedures

In the fall of 2003 and 2004, invitations to participate in a developmental study were sent to parents of all pre-kindergarten children attending one of 44 participating Head Start classrooms located in three Pennsylvania counties. These 44 classrooms were stratified by county, program features (e.g., full day versus half-day), and population demographics (e.g., percent of children of color) and randomized to receive the REDI intervention enrichments or serve as a “usual practice” Head Start control group. Parents who indicated interest in the developmental study (86% of the eligible population) were visited in their homes where informed consent was acquired and pre-intervention parent interviews were collected. Subsequently, pre-intervention child assessments were conducted at preschool by trained research assistants who were naïve concerning classroom intervention versus control status. At the end of the Head Start year, post-intervention assessments were conducted and child participants were followed longitudinally. This study focuses on interviews that were collected via telephone at two time points during early adulthood, when participants were ages 18–19 years and again when they were 21–22 years old. Study procedures complied with the ethical standards of the American Psychological Association and all methods were approved by the university Institutional Review Board. Informed consent was obtained from all participants who were compensated financially for completing assessments.

Participants

At the time of recruitment, the 356 child participants were 4.49 years old on average (SD = .31, range = 3.72 – 5.65) and (by parent report) were 25% Black, 17% Latinx, 58% White, 54% female, and 46% male. Families were low income (median annual income of $15,000 at the time of recruitment; average income-to-needs ratio of .88). All parents reported speaking some English at home; 20% noted that they also spoke Spanish at home.

Comparisons revealed that, at baseline, there was a higher proportion of Black children in the control group than the intervention group (30% vs. 20%, respectively, p < .05), but no other significant condition differences emerged on any of the demographics or child assessments included in this study (all other p > .05; details in supplementary Tables S1 and S2). Outcome data were collected for 74% (N = 263) of the original participants when they were 21–22 years old, with attrition due primarily to difficulties locating participants. Comparisons revealed that participants in the retained sample were younger at the time of enrollment than those who were not retained (p = .05), were more likely to be female (59% vs. 41%, p = .003), and were more likely to be in the preschool control group than the intervention group (50% vs. 36%, p = .02). Retained and non-retained participants did not differ significantly on any other baseline variables (all other p > .05; details in supplementary Tables S3 and S4). Data were considered conditionally missing at random (Little & Rubin, 2019) and addressed by using multiple imputations in outcome analyses (PROC MI; SAS 9.4, details below) and full information maximum likelihood (FIML) in profile analyses (Mplus, version 8.8).

Head Start REDI Intervention

In classrooms randomly assigned to the intervention group, Head Start lead and assistant teachers were provided with a set of curriculum components to supplement their usual programming in areas of SEL and language-literacy skill development. The Preschool PATHS curriculum (Domitrovich et al., 2007) provided a foundation for REDI. Teachers taught PATHS lessons over a period of 33 weeks, introducing skills using brief stories, pictures, puppet shows, and role play demonstrations during a 20-minute session at the start of each week and reinforced with an extension activity later in the week. PATHS promoted skills in four domains (prosocial behavior, emotional understanding, self-regulation strategies, and social problem-solving skills). Teachers used program posters and routines throughout the day to support generalized skill practice. For example, teachers introduced a 3-step self-control routine in a story during a PATHS lessons (“doing turtle” - tell yourself to stop, take a deep breath to calm down, say the problem and how you feel). Teachers then used classroom posters, daily reminders, and in-the-moment scaffolding to help children utilize the routine.

REDI extended PATHS by developing a daily interactive reading program to promote children’s language skills, using books aligned with the weekly PATHS themes, thereby extending the focus on SEL, as well as introducing new vocabulary and promoting narrative comprehension (Bierman et al., 2008; Gest et al., 2015). Additional REDI components included sound games (to build phonological awareness) and alphabet centers (to build print concepts; see Gest et al., 2015). Parents received handouts describing program activities with ideas for how they could support learning at home, along with 3 DVDs that illustrated REDI positive support and interactive reading strategies.

Lead and assistant teachers received intensive professional development (workshop training and weekly mentoring visits from trained REDI coaches) designed to support them in the high-fidelity implementation of these curriculum components and to promote the use of generalized teaching strategies to enhance child social-competence and self-regulation skills. These included a focus on positive classroom management, emotion coaching, strategies to scaffold child self-regulation, and the use of problem-solving dialogue (Domitrovich et al., 2007). The goal was to create nurturing, predictable, and emotionally supportive classroom environments. In addition, teacher professional development emphasized the importance of extending student-teacher conversations and incorporating new vocabulary in classroom language use to support child language development. More detailed information about the REDI program is provided in the supplementary appendix.

Measures

Young Adult Outcomes

Young adult outcome measures were collected during 60–90 minute phone calls, with participants responding to items read by trained research assistants. Measures tapped mental health (conduct problems, hyperactivity-inattention, emotional symptoms, depressive symptoms), social adjustment (loneliness, empathy, sociability, emotional support), and quality of life (healthy days, life satisfaction, security and belonging). The 4 measures reflecting mental health and the measure tapping security and belonging were collected at both time points (when participants were age 18–19 and age 21–22); the other 6 measures were collected only once, during the age 21–22 interview. When measures were collected twice, they were averaged across the two data collection waves, so that each of the 11 indices of young adult well-being was represented by a single score for profile analyses.

Mental health.

Conduct problems, hyperactivity-inattention, and emotional symptoms were assessed with the young adult Strengths and Difficulties Questionnaire (SDQ; Brann et al., 2018), which was collected during both young adult data collection waves. Each scale included 5 items rated on a 3-point scale (from 0 = not true to 2 = certainly true); responses on each scale were scored and then averaged across the two waves of data collection. Conduct problem items focused on oppositional and antisocial behaviors (disobedience, fighting, stealing; α_{Age 18–19} = .57 and α_{Age 21–22} = .42, cross-year r = .58, p < .001). Emotional symptoms included feelings of worry, unhappiness, and fears (α_{Age 18–19} = .77 and α_{Age 21–22} =.76, cross year r = .57, p < .001). Hyperactivity-inattention items included restlessness, fidgeting, and concentration difficulties (α_{Age 18–19} = .72 and α_{Age 21–22} =.76, cross year r = .53, p < .001), Internal consistency was comparable to that found in prior studies (Muris et al., 2003). Despite the low internal consistency of the conduct problems scale, prior study evidence supports its test-retest reliability and predictive validity (Muris et al., 2003).

Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (CES-D; Radloff,1977). This 20-item questionnaire measures the presence and severity of depressive symptoms experienced in the past week, including depressed affect, feelings of hopelessness, somatic symptoms, and interpersonal challenges. Items were rated on a 4-point scale (0 = rarely to 3 = almost all the time). This scale was collected during two data collection waves (α_{Age 18–19} = .90; α_{Age 21–22} = .92; cross year r = .50, p < .001).

Social adjustment.

Measures reflecting social adjustment were collected once in young adulthood, during the age 21–22 interview. Loneliness was assessed with a scale that included three items from the widely-used Loneliness Scale (I feel lonely, I feel left out, Parker & Asher, 1993) and two items from the Brief Fear of Negative Evaluation scale (I worry about what other people think of me, I’m afraid that people don’t like me, Carleton et al., 2007). Items were rated on a 4-point scale reflecting the frequency of the feeling (almost never to almost always) and averaged (α = .88). Prior studies have documented the developmental stability and longitudinal transactions linking loneliness and fear of negative evaluation, documenting their collaborative contributions to feelings of social isolation and alienation (Geukens et al., 2022).

Participants’ perceptions of their sociability and empathy were assessed using a measure from the Australia Longitudinal Study (Smart & Sanson, 2003) with items rated on a 5-point scale (from never to always). Three items assessed sociability (I find it easy to make friends, I invite others to join in social activities) and were totaled (α = .74). Five items assessed empathy (I try to be a kind and caring person, I show my concern for others when they experience difficulties) and were summed (α = .80). These dimensions of social competence have featured centrally in validated models of young adult positive development (Hawkins et al., 2009).

Emotional support was assessed using a measure from the National Institutes of Health (2016) toolbox. The 8 items focused on the availability of trustworthy individuals who understood their feelings and provided advice to help them manage stress and deal with problems. Items were rated on a 5-point scale (from never to always) and summed (α = .96).

Quality of life.

During the age 21–22 interview, participants were asked a question drawn from the Centers for Disease Control and Prevention health-related quality of life assessment (Hennessey et al., 1994): “During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?” Following CDC guidelines, the number of days reported was subtracted from 30 to provide an index of healthy days.

The age 21–22 interview also included an 8-item measure developed for this study to tap participants’ overall life satisfaction based on item content in the Students’ Life Satisfaction Scale (Huebner, 1991) and the PROMIS subjective well-being measure (Ravens-Sieberer et al., 2014). Participants rated their overall life satisfaction (I like how my life is going) and satisfaction in social, work, and leisure domains (I am satisfied with my work situation) using a 7-point scale (1 = strongly disagree to 7 = strongly agree) and responses were summed (α = .87).

Finally, a measure reflecting participants’ feelings of security and belonging was created for this study by adapting items from the People in My Life measure (PIML, Murray & Greenberg, 2000) to assess participants’ feelings of security, safety, and relational connectedness. Items were adapted to reflect the contextual and relational transitions experienced by young adults, focusing on feelings of security and connectedness in home and work or school contexts (I like the people I spend time with at home; I feel like I fit in and belong at my school or in my workplace). The 9 items were rated on a 4-point scale (from almost never to almost always) and were included in both young adult data collection waves (α_{Age 18–19} = .84 and α_{Age 21–22} =.83, cross year r = .36, p < .001). The low cross-year correlation likely reflects the frequent changes in living and work or school contexts that participants experienced after high school. Averaging these scores created a single index representing experiences of security and belonging over the course of the normative transitions that characterize the emerging adult period.

Adverse Childhood Experiences (ACES)

ACEs were defined broadly in this study to include stressful experiences that often co-vary with socioeconomic disadvantage and increase child exposure to threat and potential harm, disrupt secure caregiving, and increase unpredictability and stress (Metzler et al., 2017). They were assessed via parent report at study enrollment. These ACEs and their prevalence in the sample were: 1) concern regarding child abuse (11%); 2) frequent use of corporal punishment -- swatting or spanking 5 times or more in the last week (14%), 3) period of living apart from the primary caregiver (25%); 4) parent receipt of special education services (26%); 5) witnessing interpersonal violence (30%); 6) parent experience of grade retention (39%); 7) 3 or more family moves (43%); 8) parent history of arrest (46%); and 9) parent depression based on the CES-Depression Scale clinical cut-off score (49%). These items were combined into a cumulative score using an item response theory (IRT) model (R 3.4.3; R Core Team, 2017) in which items were weighted based on their frequency and discernment (e.g., ability to differentiate children with higher vs. lower overall risk scores). Prior studies have identified threshold effects associated with higher levels of ACEs exposure (Martin & Sellbom, 2025; Tabone et al., 2022), but the cut point used to identify the “high ACEs” subgroup has varied across studies as a function of the sample and ACEs measure used. For this study, children were divided into subgroups experiencing higher ACEs (cumulative weighted score in the top third of the sample; comparable to 4 or more ACEs) or lower ACEs (bottom two thirds of the sample.) This threshold is similar to that used in prior studies to identify children who subsequently developed behavior problems or mental health disorders (Giovanelli et al., 2020; Martin & Sellbom, 2026).

Plan of Analysis

Prior to conducting analyses, 40 imputed data sets were created (SAS 9.4, Proc MI) using a data set that included all of the outcome measures listed above, the ACEs score, child demographic variables (sex, race/ethnicity, age), family demographic variables (maternal education, income-to-needs ratio, and single parent status), baseline assessments of child cognitive skills (vocabulary, block design, executive functions, task orientation, see supplementary Table S5 for details), and research design parameters (cohort, Head Start county site, Head Start classroom). Imputations were carried out separately for control and intervention groups to preserve their covariance structures. After imputation, outcomes and moderators were standardized for analyses in order to produce coefficients that represent effect sizes in standard deviation units, approximating Cohen’s d (Feingold, 2015) for group comparisons.

The first set of preliminary analyses explored the long-term impact of the REDI preschool intervention and exposure to ACEs in early childhood on the eleven measures that represented the components of well-being, reflecting mental health, social adjustment, and quality of life. Hierarchical linear models (HLM) models nested students in Head Start classrooms (the unit of randomization) and included a set of demographic covariates (child sex, age, race/ethnicity, maternal education) and research design features (cohort and county site). These HLM analyses were then repeated with an added interaction term (intervention * ACEs) in order to explore the possibility that high levels of exposure to early ACEs moderated intervention effects on any of the component measures representing well-being.

The next set of analyses evaluated REDI preschool intervention effects on the primary outcome -- a multi-faceted profile of young adult well-being comprised of the inter-dependent constellation of measures reflecting mental health, social connectedness, and quality of life. Latent profile analyses were conducted to create profiles representing young adult well-being based on the eleven outcome measures. Then, intervention and early ACEs were included as predictors of profile placement, accounting for the original nesting of children in Head Start classrooms. The intervention * ACEs interaction was also included in the predictive model to explore potential moderation of intervention effects on profiles of young adult well-being.

Transparency and Openness

These analyses were pre-registered in the Registry of Efficacy and Effectiveness Studies #16840. The data and code necessary to reproduce the analyses are available upon request from the first author. Materials needed to replicate the intervention can be accessed at the project website, https://sites.psu.edu/redi/.

Results

Preliminary Analyses

Table 1 presents the means and standard errors for the eleven measures of well-being for the intervention and control groups, and separately, for the subgroups of participants exposed to higher or lower levels of ACEs prior to study enrollment. Table 2 presents the correlations among these eleven measures. Associations among outcomes within each of the three domains studied (mental health, social adjustment, and quality of life) were generally moderate to strong, revealing coherence within each domain. Anticipated associations were also evident across domains, with moderate correlations between ratings of mental health difficulties, less favorable social adjustment, and lower quality of life.

Table 1. Descriptive Statistics for Study Variables by Intervention Condition and ACEs Exposure.

	Outcomes	Intervention		Control		Higher ACEs		Lower ACEs
		Mean	(S.E.)	Mean	(S.E.)	Mean	(S.E.)	Mean	(S.E.)
	Mental Health
1	Conduct Problems	1.63	(1.19)	1.88	(1.14)	1.99	(1.24)	1.63	(1.13)
2	Hyperactivity	3.99	(2.05)	4.30	(2.04)	4.66	(1.95)	3.89	(2.06)
3	Emotion Symptoms	3.56	(2.10)	3.89	(2.15)	3.91	(2.29)	3.63	(2.05)
4	Depression	14.34	(8.15)	16.33	(9.23)	16.06	(9.78)	14.90	(8.17)
	Social Adjustment
5	Loneliness	2.02	(0.90)	2.30	(0.99)	2.17	(0.99)	2.14	(0.94)
6	Empathy	4.28	(0.61)	4.12	(0.58)	4.16	(0.62)	4.23	(0.59)
7	Sociability	3.56	(0.89)	3.39	(0.86)	3.38	(1.00)	3.53	(0.81)
8	Emotional Support	4.41	(0.75)	4.14	(0.94)	4.21	(0.86)	4.32	(0.85)
	Quality of Life
9	Healthy Days	27.37	(4.47)	25.56	(6.58)	26.15	(6.04)	26.71	(5.41)
10	Life Satisfaction	3.87	(0.82)	3.67	(0.84)	3.66	(0.82)	3.83	(0.84)
11	Security/Belonging	2.45	(0.40)	2.39	(0.42)	2.35	(0.40)	2.45	(0.41)

Note: Hyperactivity = hyperactivity-inattention. Depression = depressive symptoms. Means and standard errors are derived from HLM analyses based on 40 imputed data sets that account for initial nesting in Head Start classroom and are adjusted for covariates (Head Start county, child sex, age, race/ethnicity, and parent education levels.) Mean values represent average item scores for all variables except depressive symptoms (total score) and health days (mean days out of 30).

Table 2. Correlations Among Young Adult Outcomes.

	Constructs	1	2	3	4	5	6	7	8	9	10
	Mental Health
1	Conduct Problems	--
2	Hyperactivity	.38**	--
3	Emotion Symptoms	.27**	.45**	--
4	Depression	.42**	.41**	.77**	--
	Social Adjustment
5	Loneliness	.32**	.29**	.60**	.64**	--
6	Empathy	−.31**	−.20**	−.01	−.11	−.05	--
7	Sociability	−.32**	−.30**	−.46**	−.46**	−.41**	.31**	--
8	Emotional Support	−.30**	−.23**	−.26**	−.45**	−.45**	.38**	.36**	--
	Quality of Life
9	Healthy Days	−.18**	−.19**	−.32**	−.32**	−.29**	.06	.09	.27**	--
10	Life Satisfaction	−.42**	−.38**	−.52**	−.66**	−.65**	.26**	.40**	.57**	.32**
11	Security/Belonging	−.41**	−.37**	.−.39**	−.53**	−.39**	.21**	.34**	.34**	.20**	.55**

Note: Hyperactivity = hyperactivity-inattention and emotion symptoms = emotional symptoms (SDQ).Depression = depressive symptoms (CES-D).

^*p < .05.

^**p < .001.

Exploring REDI Intervention Effects on Individual Outcome Measures

HLM analyses were conducted separately for each young adult outcome measure to explore main effects associated with intervention status and ACEs exposure. Statistically significant intervention effects emerged on seven of the eleven outcomes (see Table 3). Coefficients approximate Cohen’s d, offering an estimate of the effect size on each outcome measure. The intervention was associated with lower levels in the intervention group compared with the control group on young adult measures of conduct problems, β = −.23, SE = .10, p = .03, depressive symptoms, β = −.21, SE = .10, p = .04, loneliness, β = −.30, SE = .13, p = .02, and higher levels on young adult measures of empathy, β = .29, SE = .12, p = .02, emotional support, β = .31, SE = .12, p = .01, healthy days, β = .33, SE = .13, p = .01, and life satisfaction, β = .27, SE = .13, p = .04. Non-significant trends (p < .10) that favored the intervention group relative to the control group emerged on 2 additional outcomes -- emotional symptoms and sociability.

Table 3. Main Effects of Preschool Intervention and Early ACEs on Young Adult Outcomes in HLM Analyses.

	Intervention		Control		REDI Effect		Higher ACEs		Lower ACEs		ACEs Effect
	Mean	(S.E.)	Mean	(S.E.)	Est.	(S.E.)	Mean	(S.E.)	Mean	(S.E.)	Est.	(S.E.)
Mental Health
Conduct Problems	−.05	(.07)	.18	(.07)	−.23*	(.10)	.23	(.09)	−.09	(.06)	.32**	(.11)
Hyperactivity	−.03	(.07)	.13	(.08)	−.15	(.10)	.21	(.09)	−.09	(.06)	.30**	(.11)
Emotion Symptoms	−.04	(.06)	.13	(.07)	−.16+	(.09)	.17	(.08)	−.07	(.05)	.24*	(.10)
Depression	−.06	(.07)	.15	(.08)	−.21*	(.10)	.16	(.08)	−.06	(.06)	.22*	(.10)
Social Adjustment											.	.
Loneliness	−.12	(.09)	.18	(.10)	−.30*	(.13)	.10	(.10)	−.03	(.07)	.13	(.12)
Empathy	.10	(.08)	−.17	(.09)	.29*	(.12)	−.06	(.10)	.01	(.07)	−.07	(.13)
Sociability	.06	(.09)	−.18	(.10)	.24+	(.13)	−.20	(.11)	.08	(.07)	−.29*	(.13)
Emotional Support	.11	(.09)	−.20	(.09)	.31**	(.12)	−.14	(.11)	.04	(.07)	−.18	(.13)
Quality of Life
Healthy Days	.13	(.09)	−.20	(.10)	.33*	(.13)	−.11	(.11)	.04	(.07)	−.15	(.14)
Life Satisfaction	.07	(.09)	−.21	(.10)	.27*	(.13)	−.23	(.11)	.09	(.07)	−.33*	(.13)
Security/Belonging	.01	(.07)	−.10	(.08)	.12	(.10)	−.16	(.09)	.07	(.06)	−.22*	(.10)

Note: Est. = estimate. SE = standard error. All measures were standardized within the sample for analyses. Results are shown for HLM analyses based on 40 imputed data sets that account for initial nesting in Head Start classroom and are adjusted for covariates (county, child sex, age, race/ethnicity, and parent education levels.) This model included main effects for intervention and ACEs only (no interaction term).

^*p < .05.

^**p < .01.

Statistically significant effects associated with ACEs emerged on 7 of 11 outcomes. These included higher levels for children with higher (versus lower) early ACEs exposure on young adult measures of conduct problems, β = .32, SE = .11, p = .003, hyperactivity-inattention, β = .30, SE = .11, p = .01, emotional symptoms, β = .24, SE = .10, p = .02, and depressive symptoms, β = .22, SE = .10, p = .02, and lower levels on young adult measures of sociability, β = −.29, SE = .13, p = .03, life satisfaction, β = .33, SE = .13, p = .01, and security/belonging, β = −.22, SE = .10, p = .03.

Exploring Moderation of REDI Intervention Effects on Individual Outcome Measures

The interaction term was added to the HLM analyses to explore potential moderation of intervention effects on young adult outcomes by early ACEs exposure. Two of the 11 outcomes showed significant moderation: empathy, β = −.58, SE =.25, p = .02, and sociability, β = −.52, SE =.25, p = .04. All other interaction terms were non-significant, p > .10. Adjusted mean plots were created to understand the nature of moderation (see Figure 1). For both outcomes, the intervention benefits were amplified and significant for young adults exposed to higher levels of ACEs as young children, buffering the negative impact of early ACEs exposure on young adult empathy and sociability. It should be noted that the lack of significant moderation by ACEs on most of the outcome measures suggests a generally robust intervention effect across ACE levels, with moderation emerging as the exception rather than the general rule.

Figure 1. REDI Intervention Effects for Young Adults Exposed to Higher and Lower ACEs.

Note: HLM models (with participants nested in Head Start classrooms) revealed significant interaction effects (intervention * ACEs) on empathy, β = −.58, SE =.25, p = .02, and sociability, β = −.52, SE =.25, p = .04. These figures show the means adjusted for demographic covariates (child sex, age, race/ethnicity, maternal education) and research design features (cohort and county site). For both outcomes, intervention benefits were amplified and significant for young adults exposed to higher levels of ACEs as young children.

Intervention Effects on Profiles of Young Adult Well-being

To illuminate REDI effects on young adult well-being considered holistically, the eleven outcomes representing aspects of well-being were submitted to a Latent Profile Analyses using Mplus (version 8.8) incorporating FIML to account for missing data. Models specifying one to four profile solutions were considered; the Bayesian information criterion (BIC), Akaike information criteria (AIC), entropy, and group size were evaluated (fit indices for each solution are presented in Table 4). The three-profile model was selected, because although BIC, AIC, and entropy improved in the four profile solution, that profile included fewer than 2% of the participants, limiting its interpretability (see Table 4). The three profile model produced profiles reflecting: 1) higher well-being (41% of the sample), 2) moderate well-being (39% of the sample), and 3) lower well-being (20% of the sample; see Figure 2 for graphic representation and supplemental Table S6 for profile-specific means, standard errors, and confidence intervals).

Table 4. Fit Indices for the Latent Profile Analysis of Young Adult Measures of Well-being.

Number of Classes	Log Likelihood	AIC	BIC	Smallest	Entropy
1	−5070.243	10196.486	10304.906	1	1
2	−3924.272	7922.544	8058.962	0.38644	0.877
3	−3811.499	7726.999	7918.721	0.19872	0.853
4	−3755.607	7645.215	7892.242	0.02210	0.880

Note: AIC = Akaike information criterion, BIC = Bayesian information criterion. Lower values indicate a better fit. Smallest = the percent of the sample in the smallest class. We selected 10% as the smallest class size for meaningful interpretation given the sample size (Sinha et al., 2021).

Figure 2. Profiles of Young Adult Well-being.

Next, latent profile placement was predicted using a regression analyses; predictors included REDI intervention status, early ACEs exposure level, and the interaction of REDI and ACEs, with participant gender and race included as covariates. Contrasts revealed that young adults who had experienced the REDI intervention were more likely than those in the REDI control group to be in the higher well-being profile than the lower well-being profile, β = .74, SE = .38, p = .05. Young adults exposed to higher levels of ACEs in early childhood were more likely than those exposed to lower levels of early ACES to be in the lower well-being profile than the higher well-being profile, β = −.72, SE = .30, p = .02. Neither intervention nor ACEs differentially predicted placement in the moderate well-being group relative to the higher or lower well-being group, and the interaction term (intervention * ACEs) was not a significant predictor of profile placement.

Discussion

This study provides compelling evidence that enriching Head Start classrooms with intensive SEL and support for language development can enhance young adult well-being nearly two decades later. Young adults who attended Head Start classrooms using the REDI intervention enrichments reported significantly better mental health, stronger social adjustment, and more positive quality-of-life indicators than their peers who experienced “usual practice” Head Start. These long-term benefits, evident across a multi-faceted profile of well-being and statistically significant for 7 of 11 measures comprising that profile, underscore the developmental significance of early social-emotional and language competencies for shaping trajectories of mental health and well-being into adulthood. Findings also underscore the negative developmental correlates of heightened exposure to ACEs in early childhood and reinforce the potential of enriched ECE as one a strategy to partially mitigate those effects on later young adult sociability and empathy. Together, these findings suggest that early social-emotional and language competencies function not only as proximal developmental skills, but as foundational capacities that shape long-term psychological adaptation.

Sustained Impact of Early Social-Emotional and Language Supports

REDI intervention effects were evident in areas reflecting mental health, social connectedness, and overall quality-of-life evaluations. Latent profile analysis provided a meaningful synthesis of young adult functioning across these domains, with REDI participants significantly more likely than participants in the control group to place in the higher well-being profile than the lower well-being profile, illustrating broad, integrated long-term benefits of the intervention. Importantly, the profile-based findings illustrate that intervention effects reflected broad patterns of functioning across domains of well-being, reinforced by statistically significant effects on component measures of mental health, social adjustment, and quality of life. The size of the statistically significant effects fell in the small to moderate range (d = .21 to d = .33), reflecting a mean difference of one-fifth to one-third of a standard deviation for children in the intervention and control groups. These effects are notable considering the intervention involved the enrichment of Head Start curriculum components and teaching strategies compared with “usual practice” Head Start and considering the extended time lag between the preschool intervention and these young adult assessments.

These long-term effects are consistent with theoretical models emphasizing developmental cascades in which preschool gains in SEL and language skills increase positive socialization experiences in subsequent years in ways that cumulatively contribute to adult well-being (Abenavoli, 2019; Pages et al., 2023). At post-intervention and subsequent assessments during elementary school, REDI promoted children’s early emotional understanding, self-regulation, and peer relations (Welsh et al., 2020), which mediated subsequent reductions in conduct problems and emotional distress evident in adolescence (Bierman et al., 2025). The present findings highlight the value of the developmental cascades and socialization experiences initiated by the REDI preschool intervention on the well-being of study participants as they transitioned into adulthood, where they reported healthier relational and behavioral patterns (enhanced empathy and emotional support, reduced loneliness and conduct problems) as well as improved emotional and physical well-being (fewer depressive symptoms, more healthy days, and enhanced life satisfaction) relative to participants in the preschool control group. These findings suggest that boosting child SEL and language competencies increased participants’ capacity to adapt to the increasingly complex social, emotional, and behavioral demands they faced as they progressed through elementary and secondary schools and initiated life as an adult.

It is important to note that families in this sample were low income. Prior studies have found that children from socioeconomically disadvantaged backgrounds often benefit the most from preschool enrichment interventions (Cooper & Lanza, 2014; Morris et al., 2018; Yoshikawa et al., 2012). The findings are consistent with the speculation that early boosts to SEL and language competencies strengthen children’s capacities to form more positive relationships with others, more effectively regulate their emotions and behavior, and thereby adapt to and cope effectively with developmental challenges. In this way, early SEL may confer resilience and mitigate to some degree the negative impact of their socioeconomic disadvantage on their well-being (Masten & Barnes, 2018).

Documenting the long-term benefits of public investments in ECE is important because several studies have suggested that the cognitive and academic gains associated with ECE fade out during the early elementary school years (Burchinal et al., 2024). The benefits of enhanced social, emotional, and self-regulation skills may be more long-lasting because of their ongoing value in subsequent phases of development. That is, they play a key role in supporting productive classroom participation and engaged learning during the school years (Pace et al., 2018) and have value in the later workforce (Guerra et al., 2014), as well as promoting social connectedness and mental health throughout development. In addition, although these social and emotional skills can be promoted effectively by evidence-based SEL programming in elementary school (Cipriano, 2023), many schools struggle to access sufficient resources to provide the widespread, high-quality implementation of SEL programming (Rikoon et al., 2024), limiting the exposure needed to foster the “catch up” of students who enter school without foundational social, emotional, and self-regulation skills (Abenavoli, 2019; Burchinal, 2023).

The Enduring Impact of Early Adversity

Also consistent with prior research, study findings document links between heightened exposure to ACEs in early childhood and poorer outcomes in young adulthood in areas of elevated externalizing behavior and internalizing symptoms, and diminished sociability and life satisfaction. These findings reinforce prior evidence that early adversity disrupts social and emotional development, increases stress reactivity, and undermines psychological well-being over time (Evans & De France, 2022; Oldfield et al., 2015). The impact of higher ACEs exposure within this economically-disadvantaged sample highlights the compounding burden carried by children growing up in poverty and exposed to chronic adversity. Even within a uniformly low-income sample, high ACEs exposure meaningfully differentiated later outcomes, illustrating the importance of considering cumulative risk rather than relying solely on demographic markers of socioeconomic hardship. These results underscore the importance of conceptualizing early adversity as cumulative and relational, rather than as a single-domain or static exposure.

Protecting children from the negative impact of ACEs requires attention to the multiple factors that contribute to the social marginalization of families and associated stressors that reduce the safety and security of family and community support (Matjasko et al., 2022). Enriching preschool with intensive SEL may be one helpful approach although evidence of moderation was limited. For 2 of the 11 outcomes studied – sociability and empathy -- moderation analyses documented amplified REDI intervention benefits for young adults who had experienced higher levels of early ACEs. This pattern suggests that children facing greater adversity may particularly benefit from interventions that strengthen emotional understanding, relational skills, and supportive connections with peers and teachers. The lack of moderation on other outcomes suggests that the benefits of intensive preschool SEL were robust across higher and lower levels of ACEs exposures among children in this socioeconomically disadvantaged sample. Importantly, there was no evidence that high ACEs attenuated or undermined children’s ability to benefit from the intervention.

Study Strengths and Limitations

Key strengths of this study include the use of a rigorous RCT design that increases the confidence with which benefits favoring the intervention over the control group can be linked causally with the preschool intervention. Most of the recent studies evaluating the long-term benefits of ECE have relied on quasi-experimental designs and researchers have identified the need for rigorous experimental designs that identify causal links between specific preschool components and long-term benefits as this study does (Burchinal, 2023). An additional strength involves the long-term follow up of study participants with a good retention rate, and the capacity to reference prior analyses to identify longitudinal continuities in intervention effects. The Chicago School Readiness Program also followed participants involved in a RCT of SEL enrichments in Head Start and documented some sustained benefits at the high school transition, although effects faded by the end of high school (Watts et al., 2023). Additional longitudinal follow-up studies based on rigorous RCT designs are needed to bolster the evidence base and clarify the nature of sustained benefits associated with intensive SEL enrichment during preschool, as well as the factors that may influence variability in program impact over time.

Several study limitations warrant consideration. First, follow-up assessments in young adulthood relied on self-report measures, which may be influenced by recall bias or social desirability. Second, despite the strong overall retention rate, differential attrition by intervention group and gender raises the possibility of small biases in long-term estimates that may not be completely mitigated by the use of missing data techniques such as multiple imputation and FIML. Third, ACEs were measured only at baseline through parent report and did not capture adversities that occurred later in childhood. Future research is needed to better understand how the timing and duration of ACEs exposure is related to development. In addition, although the decision to dichotomize the ACEs score was based on prior research documenting threshold effects for ACEs on child adjustment (Oldfield et al., 2015) and intervention moderation (Tabone et al., 2022), it is also the case that the cut point used to identify a “high ACEs” subgroup varies across studies and appears dependent upon the sample and measure used to assess ACEs. In this study, the cut point was based on an IRT scoring of a 9-item scale and represented approximately 4 or more ACEs which is similar to the cut point used in some prior studies (Martin & Sellbom, 2026), but variations in the ACEs measure used, scoring method, or cut-point selection could have influenced the findings. Fourth, the study was conducted in three Pennsylvania counties; while the sample reflects the demographics of many Head Start communities, results may not generalize fully to other geographic or cultural contexts.

Implications for Policy and Practice

Nonetheless, the findings make a strong case for sustained investment in SEL-enriched early childhood programming. As rates of loneliness, depression, and social isolation rise among today’s young adults, identifying preventative strategies that cultivate resilience early in development is critically important (Anderson et al., 2025; APA, 2025). REDI’s long-term benefits suggest that embedding intensive SEL programming (including evidence-based SEL curricula, interactive reading featuring aligned SEL themes, and teacher coaching to support high-quality student-teacher interactions and conversations) into public preschool programs can yield durable improvements in well-being. Head Start and other publicly funded ECE systems can leverage these findings to enhance program impact—supporting teachers in delivering structured SEL lessons, fostering emotionally supportive classrooms, and strengthening language-rich interactions. This kind of programming may be especially valuable in preschools serving children exposed to socioeconomic disadvantage and related ACEs. The general benefits observed in this sample of children from low-income families and the amplified benefits observed for children with higher ACEs exposure within the sample highlight the potential of early SEL programming to reduce inequality by buffering the long-term effects of poverty and adversity. Integrating trauma-informed approaches with SEL and language supports may further enhance outcomes for children experiencing chronic stress. These findings reinforce the importance of prevention-oriented investments that strengthen developmental systems before mental health problems become entrenched. Additional research is needed to more fully delineate the key preschool components and practices that produce the greatest long-term benefits for children affected by socioeconomic disadvantage. Variations in impact have appeared when preschool programs are scaled up and delivered to children and families in different communities and ECE contexts (Head Start, community based childcare centers, public school preK programs), as well as when programs are delivered to children and families of different cultural backgrounds and varied early experiences (Morris et al., 2018). Additional research focusing on issues associated with the scaling up of evidence-based preschool intervention models like REDI is needed, with attention to implementation fidelity, cost, and variations in impact. Future research can broaden our understanding of “what works best for whom” in ways that can guide program design and policies that address current disparities in school readiness and confer lasting benefits to young children.

Conclusion

This study demonstrates that enriching Head Start with intensive, evidence-based SEL and language supports can produce lasting improvements in young adult well-being, even amid the challenges of poverty and exposure to early ACEs. By fostering social and emotional competence, strengthening language skills, and nurturing supportive classroom environments, early intervention can alter developmental trajectories in ways that endure in adulthood. As public concern about young adult mental health intensifies, these findings highlight the power of early preventive investment to promote resilience and reduce disparities among vulnerable children. Together, these findings provide rare and valuable evidence supporting the long-term developmental significance of preschool SEL programming in public preschool settings.

Impact and Implications Statement:

This study illustrates the value of enriching early education programs for children growing up in poverty with social and emotional learning (SEL) and support for language development. Relative to children attending Head Start classrooms using usual practices, children in classrooms enriched with evidence-based curriculum components and teacher coaching to support SEL and language development showed higher levels of well-being in early adulthood, including better mental health, social adjustment, and overall life satisfaction. Greater exposure to adverse childhood experiences (ACEs) was associated with less positive early adult outcomes but did not diminish positive response to the intervention. In two areas of social adjustment (sociability, empathy), response to intervention was amplified for children with higher levels of early exposure to ACEs. Enriching preschool programming with support for SEL and language development can enhance the adult well-being of children growing up in challenging circumstances.