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School readiness among children with behavior problems at entrance into kindergarten: results from a US national study
Abstract
The impact of behavior problems on kindergarten readiness is not known. Our objective was to estimate the association between behavior problems and kindergarten readiness on a US national sample. In the US educational system, kindergarten is a natural point of entry into formal schooling at age 5 because fewer than half of the children enter kindergarten with prior formal preschool education. Parents of 1,200 children who were scheduled to enter kindergarten for the first time and were members of the Harris Interactive online national panel were surveyed. We defined behavior problems as an affirmative response to the question, "Has your child ever had behavior problems?" We validated this against attention deficit hyperactivity disorder diagnosis, scores on a reliable socioemotional scale, and child's receipt of early intervention services. We used linear, tobit, and logistic regression analyses to estimate the association between having behavior problems and scores in reliable scales of motor, play, speech and language, and school skills and an overall kindergarten readiness indicator. The sample included 176 children with behavior problems for a national prevalence of 14% (confidence interval, 11.5-17.5). Children with behavior problems were more likely to be male and live in households with lower income and parental education. We found that children with behavior problems entered kindergarten with lower speech and language, motor, play, and school skills, even after controlling for demographics and region. Delays were 0.6-1 SD below scores of comparable children without behavior problems. Parents of children with behavior problems were 5.2 times more likely to report their child was not ready for kindergarten. Childhood behavior problems are associated with substantial delays in motor, language, play, school, and socioemotional skills before entrance into kindergarten. Early screening and intervention is recommended.
... Children in preschool and early elementary grades can sometimes engage in persistent challenging behaviors (PCBs). PCBs can result from not being ready for school and/or having social-emotional delays (Bettencourt et al. 2018;Crane et al. 2013;Montes et al. 2012). PCBs can also lead to potentially negative impacts on children's own educational development in school and life-long consequences (Bettencourt et al. 2018;DiPrete and Jenninges 2012;Loson and Gillespie 2012;Skiba et al. 2014). ...
... These benchmarked skills included managing emotions and getting along with peers. Montes et al. (2012) found that parents of children who engaged in PCBs reported feeling as though their children were not prepared for kindergarten, despite being old enough to start school. Researchers reported that children who engaged in PCBs were significantly below their peers in key developmental areas, with the most significant areas being social-emotional delays and play skills (Montes et al. 2012). ...
... Montes et al. (2012) found that parents of children who engaged in PCBs reported feeling as though their children were not prepared for kindergarten, despite being old enough to start school. Researchers reported that children who engaged in PCBs were significantly below their peers in key developmental areas, with the most significant areas being social-emotional delays and play skills (Montes et al. 2012). ...
Children in early childhood classrooms (i.e., preschool through early elementary) who engage in persistent challenging behaviors often show social-emotional delays and are at risk for grade retention, referral to intervention or special education, and long-term educational and societal consequences. The social-emotional delays children with persistent challenging behaviors have could impact play skills, emotional regulation, and social interactions with peers. These skills impact their ability to function within their classroom environment. However, if the classroom teacher is able to promote a socially inclusive classroom environment that integrates children into the classroom community, ensure equitable and active participation in social activities with typically developing peers, and promote reciprocal and positive relationships with peers and adults, children who engage in persistent challenging behaviors may be more successful in school, and have more positive outcomes. The purpose of this paper is to identify ways to create a socially inclusive environment for children who engage in persistent challenging behaviors and/or who have social-emotional delays or disabilities.
... This shift in perspective is attributed in part to the high variability of skills and knowledge demonstrated in students entering school at age five (Gullo, 2015;Regenstein et al., 2017). Although a universally accepted definition of SR does not yet exist (Ackerman & Barnett, 2005;Sabol & Pianta, 2017), most SR definitions include not only academic skills but also consider physical development and social, emotional, and behavioral functioning (Hanover Research, 2013;Guhn et al., 2007;Montes, Lotyczewski, Halterman, & Hightower, 2012). This multi-disciplinary focus considers the range of skills that may contribute to a student's ability to participate in and benefit from school experiences. ...
... In addition to individual student abilities, SR is influenced by the external environment, such as socioeconomic status and parent education level (Gullo, 2015;Montes et al., 2012;Regenstein et al., 2017). Previous research suggests that low socioeconomic status can negatively influence children's SR (Gullo, 2015;Hair, Halle, Terry-Humen, Lavelle, & Calkins, 2006;Lloyd & Hertzman, 2009;Manfra, 2018;Pianta, Cox, & Snow, 2007). ...
... These findings highlight the importance of considering social, family, and community factors when conceptualizing and evaluating SR. Thus, many definitions consider not only student readiness but also the readiness of the school, family, and community to support skill and knowledge development as the student enters school (Ackerman & Barnett, 2005;High & the Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health, 2008; Montes et al., 2012;Regenstein et al., 2017;Texas Early Learning Council, 2011). Readiness of the school SCHOOL READINESS ASSESSMENT POLICY 5 can refer to policies and practices that guide teaching children at various developmental stages, whereas readiness of the family and community can refer to preparedness and resources available to support a child's development (Montes et al., 2012). ...
This study summarizes state-level policies surrounding school readiness assessment. A search was conducted to collect and code school readiness policies to document key components of assessment practices in each state, such as if the assessments were mandated or recommended, timing of assessment, measures used, domains of functioning assessed, and the role of school psychologists in assessment. Results indicated that 44 states (86%) use school readiness assessments state-wide, with 34 states fully implementing and 10 states piloting a school readiness measure. Despite this widespread use, only about half of states included guidance related to how to respond to assessment data or students identified as at-risk in their policy documents. In addition, findings indicate that only four states mentioned involvement of school psychologists or other student support personnel in implementation of these assessments. Implications of this study on early childhood assessment policy and directions for future research are discussed.
... Children with early externalizing behavior problems, such as aggressive behavior, hyperactivity, and impulsivity, show significantly poorer school readiness skills and are disadvantaged in the transition to elementary school (McClelland et al., 2006;Webster-Stratton et al., 2008). Children who enter school with behavior problems are at higher risk of poor academic and social performance, as they have difficulties adapting to the school routine and the new school environment (Montes et al., 2011). ...
... We hypothesized that high social-emotional skills cannot fully compensate for weak self-regulation skills, thereby reinforcing the central role of early self-regulatory skills for behavioral adaptation in elementary school. Moreover, we hypothesized that early externalizing behaviors can undermine a positive behavioral adaptation during the transition to elementary school (see Montes et al., 2011). Based on previously found gender differences in preschoolers' self-regulatory skills, social-emotional competences, and behavior problems (Chaplin & Aldao, 2013;Chen, 2010;Hosseini-Kamkar & Morton, 2014), we also hypothesized that girls would show better behavioral adaptations in elementary school than boys. ...
Research Findings: A successful transition from preschool to elementary school requires a high level of behavioral adaptation. The aim of our study was to analyze child-related factors in preschool that facilitate a positive behavioral adaptation in the transitional period to elementary school. A cluster analysis was conducted with the data from 406 preschoolers, in order to identify profiles based on self-regulation skills, social-emotional competences, and externalizing behavior problems. Using structural equation modeling, we then tested a regression model to examine which preschool profile adequately manages to adapt their behavior for elementary school. The profile clustering showed that behavior problems occurred when self-regulation skills were low, despite existing (moderate) social-emotional competences. Moreover, low levels of self-regulation skills in preschool predicted difficulties in behavioral adaptation at school, especially concerning hyperactivity, even when children possessed moderate social-emotional competences. Practice or Policy: Most notably, the results reinforce the relevance of promoting early self-regulation skills to support children in their behavioral adaptation process during the transitional period from preschool to elementary school.
... The child's readiness for school is reflected in their competence in physical, social, emotional, cognition, language, and general learning domains (Zuckerman and Halfon 2003). Foundational skills of school readiness include, fine and gross motor, language and communication, as well as social-emotional well-being (including the ability to engage in play and self-regulate behavior) (Montes et al. 2011;Serry et al. 2014;Zuckerman and Halfon 2003). Proficiency in these skills is important for successful transition into, and ongoing success through, the primary years of school (Sheppard et al. 2013). ...
... The EDI was not used as it is a population based instrument used once a child is in the school setting for at least 12 months rather than on the preparation of the child for transition. Additionally, questions were developed that focused on the child's play skills, adaptive behaviors and performance and participation in daily activities of selfcare and of classroom tasks, as these have also been widely reported as being important to determining school readiness (Sheppard et al. 2013;Montes et al. 2011;Msall 2005). ...
School readiness is important to a positive start and success in school but children with Autism Spectrum Disorder (ASD) are at risk of not being school-ready. This study aimed to explore parent and therapist perspectives on school readiness skills of children with ASD and factors impacting on a positive mainstream school experience. A mixed methods design was used. Key findings were that school readiness depends on child and school factors, with social skills the most important child factor. The child’s experience was largely reliant on teacher and education assistant attitudes and highlighted a need for further training and support. This study identified areas of focus for early intervention as well as school-aged intervention and the need for collaborative practice.
... CB can also be culturally defined, with some behaviors being considered challenging based on one's background, race/ethnicity, and biases (Division for Early Childhood, 2017). Differences in defining CB has led to exclusionary disciplinary practices (e.g., suspension), disproportionately impacting students from underrepresented groups, boys, and students with disabilities, particularly in early childhood and elementary settings (Meek et al., 2020) Students with behavioral support needs in early grades (i.e., kindergarten or first grade) are at a higher risk for grade retention, need for intervening services, or placement in special education services than those who do not have behavioral support needs in the same grade levels (Bettencourt et al., 2018;Crane et al., 2013;Montes et al., 2012). As students with behavioral support needs continue to age, their social-emotional skill gap widens which increases the likelihood for them to need additional supports and services later in elementary school, middle school, or high school (DiPrete & Jenninges, 2012). ...
Background
Students with behavioral support needs are educated in elementary classrooms daily. However, teachers receive limited training to support students, resulting in limited preventative and intervention services for such students. It is currently unclear what types of training preservice and inservice teachers receive, their perceptions of such training, and the quality of that training.
Objective
The purpose of this systematic literature review was to identify the empirical evidence for various forms of classroom and behavior management training for preservice and inservice teacher training and participants’ perceptions of such training.
Method
A systematic literature review was conducted using PRISMA guidelines. Articles published between 2004 and 2022, based on IDEA 2004, were included. The start date of the reauthorization of IDEA in 2004 was chosen because of its implementation of positive behavior supports for students with and without disabilities.
Results
Twenty-two studies were included in the literature review based on inclusion criteria. The included studies presented findings about classroom and behavior management programs or strategies, as well as survey data based on teachers’ perceptions of classroom and behavior management training.
Conclusion
Results indicated preservice teachers receive limited training related to overall classroom management during their teacher preparation programs, but no studies could be found showing they receive any training related to behavior management. Inservice teachers receive far more training related to both classroom and behavior management but indicate a need for more training related to both.
... The transition to kindergarten signifies the beginning of increased academic demands for children compared to preschool (Rimm-Kaufman & Pianta, 2000). When children enter kindergarten, they are expected to have basic school readiness skills, often conceptualized as prerequisite intellectual, physical, and social skills to allow for kindergarten success (Montes et al., 2011). Although transitioning into kindergarten may be successful for some students, others struggle, and autistic 1 children are particularly at risk for such challenges (Marsh et al., 2017). ...
Autistic children present with unique challenges that may be associated with challenges during the kindergarten transition process. While teachers endorse transition to kindergarten practices as important, implementation of effective transition practices is inconsistent. One possible reason is limited training during pre-service education; however, research about this is scarce. This study examined pre-service teachers’ knowledge of autism spectrum disorder (ASD) and transitions to kindergarten. Findings indicate a lack of knowledge regarding both autism and transition, as well as significant differences in knowledge of autism, wherein those seeking special education certification reported higher levels of knowledge. These results highlight training opportunities for preparing pre-service teachers to better serve young autistic children.
... Although a broad range of problematic behaviors can lead to clinical significance, certain externalizing and internalizing behaviors are normative, emerge during toddlerhood, present different rates between boys and girls, and decrease by kindergarten entry for most children (Heberle et al., 2015). However, estimates indicate that in the United States, nearly one-sixth of kindergarten children may maintain or exhibit additional problem behaviors (Montes et al., 2012), which has an immediate negative impact on children's ability to learn in school settings, socialize with peers, feel good about themselves, and can lead to a host of longer-term negative consequences (Morgan et al., 2009). Documentation of the implicit racial bias of the early childhood and elementary school workforces (Neitzel, 2018) indicates this is of particular relevance to African American and Latinx families whose children are more likely to be assessed as exhibiting problem behaviors (Gilliam et al., 2016) as well as disproportionately receive harsh punitive measures (e.g., suspensions and expulsions) than their White peers (U.S. ...
Ethnic-racial socialization is at the core of ethnic minority families’ adaptive response to a racialized social climate. Protective links between ethnic-racial socialization and children's adjustment are well documented in the adolescent years; however, very few studies have considered the ethnic-racial socialization of young children altogether and fewer still have examined the links to adjustment using longitudinal designs. Leveraging unique, longitudinal data, the present study modeled African American and Latinx caregivers’ emergent use of multiple ethnic-racial socialization strategies across the critical period when children first enter school, testing how their strategies dynamically interplay with children's early behavior adjustment. Results indicated an early pathway in which a child's behavior adjustment problems at 2.5 years may cascade to caregivers’ use of preparation for bias strategies at 3.5 years which in turn may modestly spillover in children's behavior adjustment in kindergarten. There was also modest evidence that cultural socialization strategies used in kindergarten may serve a protective function for future behavior adjustment. The potential to develop and extend interventions around both systemic issues and the direct needs of families is discussed. © 2021 The Society for the Psychological Study of Social Issues
... These inflammatory responses to PM exposure are accompanied by low birth weight, low intelligence quotient (IQ), and hypertension Harris et al. 2014;Klocke et al. 2017). Childhood cognitive and executive function are influenced by environmental exposures, healthcare system, and neighborhood contexts (Karimzade et al. 2014;Montes et al. 2012;Perou et al. 2013). ...
Evidence suggests the association between ambient airborne particulate matters and children’s IQ and psychological development in the early stages of life. However, data on the relationship between ambient air particulate matters and children’s IQ are rare in developing countries and less privileged areas. In this study, the association between PM10 and PM2.5 and the IQ of children in different areas were investigated in terms of pollution levels. In 2019, 369 children between the ages of 6 and 8 years old were randomly selected in three regions of southern Iran after screening through a questionnaire. In this study, PM10 and PM2.5 were determined using a direct reading device. IQ was surveyed according to Raymond B. Cattell scale I-A. The confounder factors including age, gender, economic conditions, maternal education, and type of delivery were adjusted. The average PM10 in areas with low, medium, and high pollution levels were measured to be 59.14±25.24 μg/m³, 89.7±37.34 μg/m³, and 121.44±43.49 μg/m³, respectively, while PM2.5 were found to be 38.97±16.87 μg/m³, 58±23.94 μg/m³, and 84.18±31.32 μg/m³, respectively. The IQ of children in the area with a high pollution was 16.628 lower than that in the area with low pollution (β= 16.628; [95% CI: 13.295 to 19.96]; P ≤ 0.0001). In addition, IQ in the area with high pollution level was found to be 7.48 lower than that in moderate pollution. ( β= 7.489; [95% CI: 4.109 to 10.870]; P ≤ 0.0001). Exposure to increased PM10 and PM2.5 is associated with decreased IQ in children.
Graphical abstract
... Motor, SE, and cognition are three of five domains of school readiness. School readiness include (a) physical health and motor development, (b) SE development, (c) cognition and general knowledge, (d) language development, and (e) approaches toward learning (Montes et al., 2012;National Education Goals Panel, 1997;Serry et al., 2014;Zuckerman & Halfon, 2003). Proficiency in these domains make preschoolers transition to kindergarten easier and are related to students' later academic and non-academic success (Johnson et al., 2013). ...
Preschoolers and kindergarteners demonstrate rapid growth and change in motor skills, socio-emotional (SE) skills, and academic performance. Data on 250 children with disabilities (CWD) and 250 typically developing children (TDC) from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) data set were analyzed to explore the relation between motor skills, SE skills and academic performance for children with and without disabilities. The ECLS-B data set is the first study to follow children from birth through kindergarten entry, collecting data on thier early development. The current study utilized descriptive and regression analyses (survey frequency, mean, and regression) were conducted using Statistical Analysis Software (SAS) version 9.2 (SAS Institute, 2008). Results indicated that both fine and gross motor skills make significant contributions to SE skills in CWD at both preschool and kindergarten and in TDC at preschool only. A significant correlation between fine and gross motor skills and academic performance was found for CWD and TDC in preschool and kindergarten. These findings indicated that an increased emphasis on the development of fine and gross motor skills during the preschool years may benefit the development of SE skills and academic performance for CWD. Results sheds light on the importance of including motor interventions as part of early childhood education programs delivered to CWD to narrow the achievement gap and ideally result in early learning success.
... La mayoría siguen necesitando servicios de educación especial (Delgado et al., 2006) y algunos son reclasificados, siendo las categorías más comunes: discapacidades de aprendizaje, discapacidades del habla y lenguaje y discapacidad intelectual educable (Bernheimer, Keogh & Coots, 1993;Delgado et al. 2006;Keogh, Coots & Bernheimer, 1996); pero otros no encajan en categorías diagnósticas, lo que conlleva a que se minimicen sus problemas y no se les proporcione una atención adecuada. Sin embargo, a lo largo de su niñez, muestran menos preparación escolar y un mayor riesgo de rendimiento escolar deficiente (Montes, Lotyczewski, Halterman, & Hightower, 2012;Romano, Babchishin, Pagani & Kohen, 2010), así como déficits en actividad, peor ejecución adaptativa y menor participación escolar (Leung, Chan, Chung & Pang, 2011). Por tanto, debe asumirse que, tanto los niños identificados en la infancia con RD -pero que no reúnen criterios para un diagnóstico de trastorno del neurodesarrollo en años posteriores-como los valorados en la etapa escolar con un diagnóstico impreciso como inmaduros, despistados o incluso vagos, presentan problemas en su desarrollo que interfieren en su aprendizaje y deben ser incluidos en una categoría diagnóstica para proporcionarles una intervención acorde a sus necesidades. ...
Un número considerable de estudiantes presenta dificultades de aprendizaje y bajo rendimiento académico, sin embargo su evaluación no siempre deriva en un diagnóstico concreto. Son categorizados como inmaduros, pero no se determinan ni la naturaleza ni las características de sus dificultades. El objetivo de este estudio fue identificar los dominios evolutivos afectados en niños con retraso del desarrollo (RD) con la finalidad de valorar el concepto de dificultades neuroevolutivas como categoría comprensiva y perfil de las dificultades generalizadas de aprendizaje. Para ello, se realizó una revisión sistemática en las bases electrónicas Medline, PsycINFO, WOS, Eric, Dialnet y CSIC y, tras aplicar los criterios de inclusión, se seleccionaron 18 artículos. Los resultados confirman que RD se utiliza como etiqueta diagnóstica para caracterizar a niños con retrasos significativos en uno o varios ámbitos del desarrollo, pero no existe una definición de consenso ni criterios específicos para su diagnóstico, y solo sería de aplicación a niños de corta edad. Los dominios afectados coinciden con funciones neuroevolutivas y, en su etiología, destacan factores de riesgo biológico y ambiental. Las dificultades neuroevolutivas abarcarían un amplio espectro de déficits con distintos niveles de gravedad que, al interactuar entre sí, dan lugar a una variedad de perfiles.
... The majority continue to require special education services (Delgado et al., 2006) and some are re-classified, with the most common categories being: specific learning disabilities, speech or language impairment and educable mental handicap (Bernheimer, Keogh & Coots, 1993;Delgado et al. 2006;Keogh, Coots & Bernheimer, 1996). Others, however, do not match diagnostic categories, which leads to their problems being minimized and a lack of provision of adequate care, even though throughout their childhood they demonstrate less readiness for school and are at a greater risk of poor school performance (Montes, Lotyczewski, Halterman, & Hightower, 2012;Romano, Babchishin, Pagani & Kohen, 2010), as well as having deficits in activity, poorer adaptation and decreased participation in school (Leung, Chan, Chung & Pang, 2011). Therefore, both the children identified in childhood with DD (but who do not meet the criteria for a neurodevelopmental disorder to be diagnosed in later years) and those who at school age are given an imprecise diagnosis such as being immature, absentminded or even lazy, must be assumed to have developmental problems that interfere with their learning and must be assigned to a diagnostic category in order to provide them with treatment that meets their needs. ...
Abstract: A considerable number of students have learning difficulties and
low academic performance, yet their evaluation does not always lead to a
concrete diagnosis. They are categorized as immature, but neither the nature nor the characteristics of their difficulties are determined. The aim of
this study was to identify the developmental domains which are affected in
children with developmental delay (DD) and assess the concept of neurodevelopmental difficulties as a comprehensive construct of generalized
learning difficulties. To this end, a systematic review was carried out on the
electronic databases Medline, PsycINFO, WOS, Eric, Dialnet and CSIC
and, after applying the inclusion criteria, 18 articles were selected. The results confirm that DD is used as a diagnostic label to characterize children
with significant delays in one or more developmental domains, but there is
no definition of consensus nor specific criteria for its diagnosis, and it is
only to young children. The affected domains coincide with neurodevelopmental functions, and biological and environmental risk factors stand
out in their aetiology. The association between a persistence of neurodevelopmental difficulties in childhood and generalized learning difficulties is
verified, suggesting that the former are an explicative construct of the second.
Keywords: Developmental delay; learning disabilities; neurodevelopmental
difficulties; neurodevelopmental disabilities; academic achievement.
... Children's neurodevelopmental delays are usually continuous or persistent and may predict learning disabilities at school [26,41,42]. Detecting and addressing these delays in their early phase helps health professionals to make decisions about supportive and need-based interventions for children well before school starts [43,44]. While investing in evidence-based interventions, new approaches should also be explored. ...
Active play is regarded as physical activity during early childhood. Physical activity has many benefits for children’s physical and psychosocial health and wellbeing, as well as for their cognitive development. The aim of this study was to investigate associations between the preference for active play and neurological development in toddlers. The study was conducted as a register-based study, and the data were collected from a public-health clinic’s electronic health records. The register data about active play used in this study were originally assessed by parents at home and by early years teachers at nurseries. Neurological development was assessed by the public health nurses in public child-health clinics. The data eligible for this study were available from 717 toddlers aged 2.5–3.0 years old (mean: 2.5 years ± 2 months). The majority of toddlers (85%) showed a preference for active play, both at home and at the nursery. The prevalence of delays in the neurological development of toddlers varied in different developmental areas (by 1–15%). Delays in gross motor competence, auditory perception, and self-help skills were associated with a lower preference for active play in nursery settings, but none of the neurodevelopmental items were found to be associated with toddlers’ preference for active play at home. Nurseries need to encourage children to actively play and support their gross motor competence and self-help skills.
... Problem behaviors tend to occur very early in life (Bagner et al. 2012); they may become observable as early as 12 months (Carter et al. 2003; van Zeijl et al. 2006). Additionally, empirical evidence has shown that prevalence rates of behavioral problems for preschool children is quite high across cultures, albeit to variying levels (i.e., 16% in a German sample, Fuchs et al. 2013; 14% in a US sample, Montes et al. 2012;25.1% in a Taiwanese sample, Wu et al. 2012). Other studies have found the intensity of the problems tends to remain unchanged from the ages of 3-4 through 4-5 years of age (Eisenhower et al. 2009), or from preschool to childhood and adolescence (Renk 2011). ...
Objectives
We aimed to explore profiles of mothers with respect to two key risk factors, SES and parenting stress, and then examine the role of maternal perceived social support and negative intentionality in toddlers’ internalizing and externalizing behaviors in these mother profiles.
Method
A sample of 463 mothers with 1–3 years old non-clinical toddlers completed scales. First, in Latent Profile Analysis (LPA), we identified two distinct mother profiles, as high SES–low stress (low-risk) and low SES–high stress (high-risk) groups. Then, we tested the pattern of associations among maternal perceived social support, negative intentionality, and child internalizing and externalizing problem behaviors in a multi-group SEM analysis based on these two profiles.
Results
There was a strong negative association between social support and both internalizing and externalizing behaviors in the low-risk profile mothers, but not in the high-risk profile mothers. Regardless of mothers’ profiles, the perceived negative intentionality in toddlers’ behaviors positively predicted both internalizing and externalizing behaviors. However, the perceived negative intentionality did not mediate the negative association between perceived social support and toddlers’ problem behaviors.
Conclusion
Our findings suggest that mothers’ negative attributions about child’s behaviors can play a critical role at the early stages of problem behaviors and social support can be an important factor to decrease the child’s externalizing problem behaviors especially for the low-risk group of mothers. Intervention programs should be designed with the differential contribution of social support and negative intentionality in the onset of toddlers’ problem behaviors.
... In Canada, one child in six is at risk of developmental delay at school entry (Kingston and Tough, 2014), and the latest trends depict increasing prevalence (Hertzman, 2009). These delays, including communication, cognitive, social-emotional, gross and fine motor are associated with lower school readiness and poor school performance (Montes et al., 2012;Romano et al., 2010). Moreover, delay in one domain frequently has "cascading" effects on other developmental domains, all of which can have serious lifelong consequences on children's health, academic achievement, and success (Masten et al., 2005;Obradović et al., 2009). ...
Background: Existing literature on the impact of the course of maternal distress symptoms in the perinatal period and beyond has mainly focused on one source of distress (e.g., anxiety or depression) and only selected aspects of child development. This study examined the relative impact of trajectories of maternal depression, anxiety, and stress symptoms from mid-pregnancy to early childhood on child communication, gross motor, fine motor, problem solving, and personal social development at three years of age. Methods: Data were analyzed from 1983 mother-child dyads who participated in the three-year follow-up of the All Our Families (AOF) study. Maternal distress and child development across five domains were measured using validated tools. Latent class analysis (LCA) was conducted to identify trajectories of maternal distress over time. Multivariable logistic regression was used to explore the relationship between the trajectories and child development while adjusting for the covariates. Results: At age three years, 5.2% of children were at risk communication delay; 12.7% for gross motor delay; 15.4% for fine motor delay; 11.2 for problem solving delay; and 5.6% for personal-social delay on ASQ-3 domains. Multivariable analysis showed children born to mothers with persistent high anxiety symptoms from pregnancy to 3-years postpartum had an increased risk of delays in communication and personal-social domains. Limitations: The use of self-reported maternal mental health symptoms and maternal reported child development are the study limitations. Conclusions: The impact of high levels of maternal anxiety symptoms on the increased risk of child developmental delay in communication and personal-social domains highlights the importance of early intervention and addressing maternal anxiety from pregnancy through early childhood.
... A review of 26 studies reported that 71% of preschool and school-age children diagnosed with an emotional or behavioral disorder also exhibited language deficits, and 57% of children diagnosed with language deficits were also diagnosed with an emotional or behavioral disorder (Benner, Nelson, & Epstein, 2002). In longitudinal research, elevated levels of externalizing behavior problems in early childhood are associated with subsequent language problems in kindergarten (Benner et al., 2002;Gremillion & Martel, 2014;Montes, Lotyczewski, Halterman, & Hightower, 2012). Therefore, intervening as early as possible, such as during the transition from infancy to toddlerhood and around the time when challenging behaviors (e.g., tantrums, aggression) are first detectible (Briggs-Gowan, Carter, Skuban, & Horwitz, 2001) and expressive language is first being used (Hawa & Spanoudis, 2014), may help reduce the risk of these associated negative behavioral and language outcomes. ...
The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the child-directed interaction phase of parent–child interaction therapy, on infant language production. Participants were 60 infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers, who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the infant behavior program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers’ use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.
... Oleh karena itu, diperlukan penyaringan dan intervensi dini sebelum melakukan proses pendidikan. 38 Intervensi yang diberikan pada kelompok gabungan (bernyanyi dan permainan kartu bergambar) juga dilakukan pendekatan ke anak-anak dalam penyampainan pesan dari pendidikan tersebut. Sejalan dengan penelitian dengan menerapkan pendekatan ke anak-anak dalam pendidikan gizi dapat menghasilkan efek yang menguntungkan dan keuntungan dalam mempromosikan perilaku gizi di kalangan anak-anak prasekolah. ...
Pendidikan gizi pada anak taman kanak-kanak merupakan upaya meningkatkan kesadaran berperilaku hidup sehat dalam konsumsi buah dan sayuran melalui Komunikasi, Informai dan Edukasi (KIE). Penelitian bertujuan menganalisis pengaruh pendidikan gizi melalui teknik bernyanyi dan permainan kartu bergambar terhadap sikap dan perilaku gizi anak taman kanak-kanak. Desain dalam penelitian ini adalah quasi eksperimental, dengan rancangan penelitian pre-post test with control group design. Subjek penelitian ini berjumlah 68 siswa dari 4 sekolah taman kanak-kanak yang ada di Kecamatan Tempilang, penelitian dilakukan pada bulan Januari - Maret 2018. Pendidikan gizi yang digunakan adalah teknik bernyanyi, permainan kartu dan intervensi gabungan. Hasil menunjukkan ada perbedaan sikap dan perilaku gizi pada pendidikan gizi. Intervensi gabungan mempunyai nilai tertinggi pada sikap dan perilaku gizi masing-masing sebesar 7.38±0.98 dan 49.06 berbeda nyata dengan media intervensi lainnya. Terdapat perubahan sikap gizi baik yang meningkat sesudah intervensi (97,1%) dari sebelum intervensi (95,6%) dan perubahan perilaku gizi baik yang meningkat sesudah intervensi (45,6%) dari sebelum intervensi (79,4%). Pendidikan gizi melalui intervensi gabungan memberikan perubahan peningkatan sikap dan perilaku gizi pada anak taman kanak-kanak.
... Unfortunately, approximately 10% of preschoolers display social and behavioural problems (e.g., Stacks, 2005), with approximately 6% of young children displaying significant social and behavioural challenges (Briggs-Gowan, Carter, Skuban, & Horwitz, 2001). Young children who exhibit externalizing behaviours (i.e., aggressive, impulsive, and/or rule-breaking behaviours) are at risk for future school and life failures such as rejection from peers and adults, developmental delays, social skill deficits, academic difficulties, antisocial behaviour, delinquency, unemployment, substance abuse, school failure, and school dropout (Fanti & Henrich, 2010;Montes, Lotyczewski, Halterman, & Hightower, 2012;Whitted, 2011). Without early intervention, externalizing behaviours may escalate and become more resistant to intervention (Stacks, 2005;Wang, Christ, Mills-Koonce, Garrett-Peters, & Cox, 2013). ...
Early intervention is valuable in preventing negative behavioural outcomes and promoting positive social competence in young children with externalizing behaviours. Interventions that teach social problem solving (SPS) are a promising solution, as children with behavioural difficulties often have deficits in these skills. School‐based SPS programming has been shown to prevent and remediate externalizing behaviours for older children, but a summary of its effectiveness for preschoolers in early childhood settings is unavailable. The purpose of the current meta‐analytic review was to (a) provide a summary of the characteristics of current SPS instruction in preschool settings and (b) examine the effectiveness of interventions that include an SPS component in decreasing externalizing behaviours and increasing social competence among preschoolers. Using meta‐analytic review, we present common characteristics of preschool interventions that include SPS and provide evidence for the efficacy of these interventions in reducing externalizing behaviours and increasing social competence in preschoolers.
Highlights
• We performed a meta‐analytic review of preschool social problem‐solving interventions (SPS).
• We examined both preschool‐based and home‐based reports of behavior and social competence for meta‐analysis.
• We found evidence for the efficacy of interventions in reducing externalizing behavior and increasing social competence for preschool‐based reports.
... In Canada, one child in six is at risk of developmental delay at school entry (Kingston and Tough, 2014), and the latest trends depict increasing prevalence (Hertzman, 2009). These delays, including communication, cognitive, social-emotional, gross and fine motor are associated with lower school readiness and poor school performance (Montes et al., 2012;Romano et al., 2010). Moreover, delay in one domain frequently has "cascading" effects on other developmental domains, all of which can have serious lifelong consequences on children's health, academic achievement, and success (Masten et al., 2005;Obradović et al., 2009). ...
Background:
Existing literature on maternal distress has focused on stress and anxiety during the pregnancy or postnatally and their relationship with child development. However, few studies have investigated the association between maternal stress and anxiety symptoms over time and child development in preschool children. The aim of this study was to examine the association between trajectories of maternal stress and anxiety symptoms from mid-pregnancy to three years postpartum and child development at age three years.
Methods:
Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Latent class analysis (LCA) was conducted to identify trajectories of women's stress and anxiety across from mid-pregnancy to three years postpartum. Multivariate logistic regression was used to explore the relationship between the stress and anxiety trajectories and child developmental delays while adjusting for the covariates.
Results:
LCA identified three distinct trajectories of maternal stress and anxiety symptoms over time. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ─ 5.51), p = 0.003) of having a child with developmental delays at 3 years.
Limitations:
The use of self-reported maternal mental health symptoms and no data on fathers' mental health are our study's limitations.
Conclusions:
The findings from a population-based Canadian sample provide empirical support for a relationship between maternal anxiety overtime and risk of child developmental delays. Identifying and supporting mothers experiencing high anxiety symptoms in the perinatal period may mitigate the risk of these delays in children.
... Given the short period of assessment afforded by the well-child visit, perhaps only socioemotional indicators with direct conceptual overlap are possible such as externalizing and behavior problems. Disruptive behaviors are a key school readiness outcome and it is very promising to be able to predict this from a child's distress in anticipation of the painful vaccination [38]. Although clear variability exists [39], less variability in distress post-needle than pre-needle period may be the reason other relationships were not found. ...
Social and emotional competencies, such as distress regulation, are established in early childhood and are critical for the development of children's mental health and wellbeing. Routine vaccinations in primary care provide a unique opportunity to relate responses to a universal, relatively standardized, distress regulation paradigm (i.e., pain-related distress) to key developmental outcomes. The current study sought to examine distress regulation during routine vaccination in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. It was hypothesized that children with poorer distress regulation abilities post-vaccination would have lower socioemotional development. Furthermore, it was hypothesized that insensitive parenting would exacerbate this relationship for children with poor distress regulation abilities. As part of an ongoing longitudinal cohort, 172 parent-child dyads were videotaped during vaccinations in infancy and preschool, and subsequently participated in a full-day psychological assessment in a university lab. Videotapes were coded for child pre-needle distress (baseline distress), immediate post-needle pain-related distress reactivity (immediate distress reactivity), and pain-related distress regulation (distress regulation). Parent sensitivity during the preschool vaccination was also coded. Baseline distress prior to vaccination predicted greater externalizing problems and behavioral symptoms. Parent sensitivity did not moderate the association between any child distress behaviors and socioemotional development indicators. Child distress behaviors prior to injection, regardless of parent behavior, during the vaccination context may provide valuable information to health care professionals about child socioemotional functioning in the behavioral and emotional domains.
... These symptoms not only require classroom resources [3], but also often result in disciplinary and psychological assessment referrals [8,9]. Significant ADHD symptoms prior to school entry also confer greater risk for students' experience of significant comorbid difficulties, such as difficult cognitive and behavior problems, speech and language delays, socio-emotional problems, and poor pre-academic skills [10]. Thus, students with ADHD are sure to be part of inclusive kindergarten settings and, in many cases, require significant resource commitment [9]. ...
... One in six children experiences developmental problems at school entry (Kershaw et al., 2010), and recent Canadian trends indicate increasing prevalence rates across several provinces (Hertzman, 1998(Hertzman, , 2009. Early developmental problems are associated with lower school readiness and poor school performance (Montes, Lotyczewski, Halterman, & Hightower, 2012;Romano, Babchishin, Pagani, & Kohen, 2010) and often co-occur with other concerns, affecting multiple domains of child health and development at once (Masten et al., 2004). Early intervention in the first three years of a child's life has been shown to be more effective than later remediation (Doyle, Harmon, Heckman, & Tremblay, 2009), but our ability to intervene is limited because we lack a comprehensive understanding of risk and protective factors. ...
Background:
Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies.
Aims:
To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk).
Methods and procedures:
Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses.
Outcomes and results:
At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction.
Conclusions and implications:
The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction.
... Clinical experience suggests that even mild developmental challenges among young children are frequently comorbid with psychosocial problems. The foregoing discussion is in keeping with a national survey of 1,200 parents with children entering kindergarten, which found that 14% of the children had behavioral problems that affected multiple developmental trajectories including language, motor and social functioning, and parents' perceptions of their children's school readiness (Montes, Lotyczewski, Halterman, & Hightower, 2012). Research has already established that if these social-behavioral problems are not treated or prevented effectively in early childhood, they constitute significant risk factors for later psychopathology (Fergusson, Horwood, & Ridder, 2007;Kagan & Zentner, 1996;Tolan & Dodge, 2005), academic failure (Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999;McLeod & Kaiser, 2004), and also poor physical health (Shonkoff, Boyce, & McEwen, 2009). ...
Risk factors during preschool years, such as poverty and unattended social/emotional problems, are known to have a strong negative influence on children's later functioning. This study aimed to investigate the effectiveness of an on-site integrated school-based mental health services and consultation program for preschool children and their families. The sample consisted of 47 children and parents in 3 childcare centers who came from low-socioeconomic, urban backgrounds. Parents provided questionnaire data on children's social-emotional functioning at 2 assessment times. Children's ages ranged between 2 and 4 years at Time 1. Approximately half of the sample consisted of children who were selected for and received twice-weekly peer play psychotherapy (PPP) and, at-times, other mental health services from clinicians (playgroup [PG] children). The other half of the sample consisted of better functioning non-playgroup (NPG) children from the same centers. When PG and NPG were compared at Time1, the PG children were significantly behind the NPG children justifying their assignment to PG. However, at Time 2, the difference between PG and NPG was no longer significant on vital measures of adaptation, revealing the ways in which Relationships for Growth & Learning (RfGL) Program arguably led to 'catch up'. PG children's behavioral problems and total symptomatology decreased significantly from Time 1 to Time 2. Higher dosage of PPP was linked with higher social competence and decreased behavioral problems. Areas of gain differed between internalizing and externalizing children, indicating that intervention was helpful to different types of children. Clinical and research implications were discussed. (PsycINFO Database Record
... No entanto, esses problemas estão associados a atraso do desenvolvimento motor e da linguagem, das habilidades em participar de jogos e brincadeiras em grupo, mesmo se considerarmos diferenças culturais e demográficas. Um estudo feito por Montes et al. 66 sobre crianças com problemas de comportamento encontrou atraso no desenvolvimento da prontidão escolar de 0,6-1, desvio padrão em vários testes de desenvolvimento, em comparação com crianças sem problemas comportamentais, e que os pais de crianças com problemas de comportamento foram cinco vezes mais propensos a relatar que o seu filho não estava pronto para a escola. ...
Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health.
Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child.
Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a “school readiness” checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential.
Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.
... Cognitive impairment and behavioral problems affect up to 20% of U.S. children, placing an enormous burden on the education and healthcare systems ( Boulet et al. 2009;Costello et al. 2003;Froehlich et al. 2007;Leonard and Wen 2002;Montes et al. 2012;Perou et al. 2013). As loss of early functioning may result in diminished academic and economic productivity that persists over the life span, understanding how maladaptive trajectories are set in early life and identifying environmental influences amenable to intervention are research priorities. ...
Background:
Brain growth and structural organization occurs in stages beginning prenatally. Toxicants may impact neurodevelopment differently dependent upon exposure timing and fetal sex.
Objectives:
We implemented innovative methodology to identify sensitive windows for the associations between prenatal particulate matter with diameter ≤ 2.5 μm (PM2.5) and children's neurodevelopment.
Methods:
We assessed 267 full-term urban children's prenatal daily PM2.5 exposure using a validated satellite-based spatio-temporally resolved prediction model. Outcomes included IQ (WISC-IV), attention (omission errors [OEs], commission errors [CEs], hit reaction time [HRT], and HRT standard error [HRT-SE] on the Conners' CPT-II), and memory (general memory [GM] index and its components - verbal [VEM] and visual [VIM] memory, and attention-concentration [AC] indices on the WRAML-2) assessed at age 6.5±0.98 years. To identify the role of exposure timing, we used distributed lag models to examine associations between weekly prenatal PM2.5 exposure and neurodevelopment. Sex-specific associations were also examined.
Results:
Mothers were primarily minorities (60% Hispanic, 25% black); 69% had ≤12 years of education. Adjusting for maternal age, education, race, and smoking, we found associations between higher PM2.5 levels at 31-38 weeks with lower IQ, at 20-26 weeks gestation with increased OEs, at 32-36 weeks with slower HRT, and at 22-40 weeks with increased HRT-SE among boys, while significant associations were found in memory domains in girls (higher PM2.5 exposure at 18-26 weeks with reduced VIM, at 12-20 weeks with reduced GM).
Conclusions:
Increased PM2.5 exposure in specific prenatal windows may be associated with poorer function across memory and attention domains with variable associations based on sex. Refined determination of time window- and sex-specific associations may enhance insight into underlying mechanisms and identification of vulnerable subgroups.
... 4 Such preventive efforts are critical because children with early behavior problems are 5 times more likely to be rated as lacking school readiness skills by kindergarten entry; in fact, they are more likely to show delays in motor, language, play, pre-academic, and socialemotional skills by kindergarten entry than children without early behavioral problems. 8 For very young children at higher risk, specifically those with early behavior problems growing up in economically stressed families, parenting plays a particularly critical role in buffering the effects of these risks on children's behavioral outcomes. The current study focuses on a specific type of positive parenting, maternal emotion talk, which may buffer the impact of such risk on young children. ...
To test the hypothesis that toddlers at highest risk for behavioral problems from the most economically vulnerable families will benefit most from maternal talk about emotions.
This study included 89 toddlers and mothers from low-income families. Behavioral problems were rated at 2 time points by masters-level trained Early Head Start home visiting specialists. Maternal emotion talk was coded from a wordless book-sharing task. Coding focused on mothers' emotion bridging, which included labeling emotions, explaining the context of emotions, noting the behavioral cues of emotions, and linking emotions to toddlers' own experiences. Maternal demographic risk reflected a composite score of 5 risk factors.
A significant 3-way interaction between Time 1 toddler behavior problems, maternal emotion talk, and maternal demographic risk (p = .001) and examination of slope difference tests revealed that when maternal demographic risk was greater, more maternal emotion talk buffered associations between earlier and later behavior problems. Greater demographic risk and lower maternal emotion talk intensified Time 1 behavior problems as a predictor of Time 2 behavior problems. The model explained 54% of the variance in toddlers' Time 2 behavior problems. Analyses controlled for maternal warmth to better examine the unique contributions of emotion bridging to toddlers' behaviors.
Toddlers at highest risk, those with more early behavioral problems from higher demographic-risk families, benefit the most from mothers' emotion talk. Informing parents about the use of emotion talk may be a cost-effective, simple strategy to support at-risk toddlers' social-emotional development and reduce behavioral problems.
... The developing fetus and infant are most vulnerable owing to the rapid differentiation of the central nervous system in utero and early life (Landrigan et al., 1999;Rice and Barone, 2000). Neurocognitive and behavioral deficits in childhood, including problems with learning, attention, conduct, depression and anxiety affect up to 20% of U.S. children, placing a burden on education and healthcare systems (Froehlich et al., 2007;Boulet et al., 2009;Montes et al., 2012). However, the potential loss of functioning early in life as a result of environmental factors may result in diminished academic and economic productivity that persists over the life span (Trasande et al., 2005). ...
The amount of scientific research linking environmental exposures and childhood health outcomes continues to grow; yet few studies have teased out the mechanisms involved in environmentally-induced diseases. Cells can respond to environmental stressors in many ways: inducing oxidative stress/inflammation, changes in energy production and epigenetic alterations. Mitochondria, tiny organelles that each retains their own DNA, are exquisitely sensitive to environmental insults and are thought to be central players in these pathways. While it is intuitive that mitochondria play an important role in disease processes, given that every cell of our body is dependent on energy metabolism, it is less clear how environmental exposures impact mitochondrial mechanisms that may lead to enhanced risk of disease. Many of the effects of the environment are initiated in utero and integrating mitochondriomics into children's environmental health studies is a critical priority. This review will highlight (i) the importance of exploring environmental mitochondriomics in children's environmental health, (ii) why environmental mitochondriomics is well suited to biomarker development in this context, and (iii) how molecular and epigenetic changes in mitochondria and mitochondrial DNA (mtDNA) may reflect exposures linked to childhood health outcomes. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
... Additionally, the lack of improvement in negative social-emotional characteristics over the course of the preschool year while in high quality ECE programs is similar to the findings of Lipscomb et al. (2013), who obtained marginally significant improvements in internalizing and externalizing behavior problems for children living in non-parental care and receiving Head Start services. These findings of early socio-emotional difficulties are notable as these are markers for later social-emotional problems (Bulotsky-Shearer & Fantuzzo, 2011;Montes, Lotyczewski, Halterman, & Hightower, 2012). Additionally, these kinds of socio-emotional difficulties can be challenging for the average ECE provider/teacher to handle without additional specialized services and/or early intervention services. ...
There is increasing attention being given to better coordinated early care and education (ECE) and child protection systems across the nation, as children with child protection involvement are at risk for a range of negative outcomes that have been improved through high quality ECE in other populations. However, there is little empirical evidence to demonstrate what types of ECE experiences are needed for children involved in the child protection system in order to improve their developmental outcomes. This study compared the developmental status in the year prior to kindergarten of low-income children with and without child protection involvement who were enrolled in a range of ECE settings, all of which were rated highly by a state quality rating and improvement system. Using secondary data from a large Midwestern state child protection system and a local ECE evaluation, findings demonstrated that children with child protection involvement were performing more poorly than their low-income peers without child protection involvement on measures of receptive vocabulary, math reasoning, and teacher ratings of anger/aggression and anxiety/withdrawal, but not on ratings of social competence. Growth was made in receptive vocabulary and social competence for all children and there was no significant interaction between group and time for any child outcome measure. These data suggest that children with child protection involvement continue to manifest academic and social difficulties despite attending high quality ECE programs. Implications for improving the early educational opportunities for children with child protection involvement and suggestions for future research are discussed.
... One in six children entering school experiences developmental delay [1] and trends over the past decade reveal increasing prevalence rates [2,3]. Children with developmental problems demonstrate lower school readiness and greater risk for poor school performance [4,5]. Furthermore, delay in one domain frequently has 'cascading' effects on other areas of child health and development [6], with longstanding effects on academic achievement, health, and future opportunity [7][8][9]. ...
One in six children entering school experiences developmental delay. Maternal mental health represents one of the earliest, modifiable influences in a child's life. The objective of the review was to evaluate the association between maternal mental health and school-age child development, and we hypothesized there would be a negative association. Five databases were searched (Embase, CINAHL, Eric, PsycInfo, Medline). Key journals and reference lists were hand-searched. Two reviewers assessed studies based on inclusion criteria: (1) the exposure was any form of maternal mental health occurring during pregnancy or postpartum periods; (2) the outcome was child development (>48 months to 8 years); (3) the study recruited participants from developed countries; and (4) publication was in English between January, 1990 and December, 2012. Disagreements were resolved by consensus. Study quality was assessed by two reviewers using the Scottish Intercollegiate Guideline Network and disagreements were resolved by consensus. Data extraction was conducted by one reviewer using standardized forms. Maternal mental health problems in pregnancy and/or the postpartum period increased the likelihood that school-age children experienced suboptimal global, behavioral, cognitive, and socio-emotional development. The findings highlight the need for maternal mental health assessment during the prenatal, postnatal, and early childhood periods.
Previous research reported that positive parenting and parenting stress might impact children’s psychosocial adjustment. The current longitudinal study aimed at evaluating the associations over time between mothers’ positive parenting, their parenting stress, and their preschoolers’ social–emotional competence and emotional–behavioral difficulties. Participants were 53 Italian mothers, aged between 24 and 47 years (M = 35.30, SD = 5.28) at T0, and their children (females = 51%), aged between 3 and 6 years (M = 4.48, SD = 0.84) at T0. Mothers completed self-report scales at 2 time points (with a 2-year lag). An autoregressive cross-lagged model was tested that had a good fit to the data, χ2(6) = 3.37 ns, CFI = 1.00, RMSEA = 0.00. The results showed that maternal positive parenting at T0 negatively predicted maternal parenting stress at T1; maternal parenting stress at T0 negatively predicted children’s social–emotional competence at T1. Moreover, at each time point, children’s social–emotional competence was associated positively with maternal positive parenting and negatively with maternal parenting stress; children’s emotional–behavioral difficulties were positively associated with maternal parenting stress. The results confirm that interactions with mothers are fundamental for children’s psychosocial adjustment. Implications for research and practice aimed at reducing parenting stress and fostering positive parenting are discussed.
This study focused on developing parent–professional partnerships in promoting school readiness skills for children with disabilities entering first grade. A mixed method was used to evaluate the readiness skills of 15 children from two preschools. The development of an intervention plan was the focus of the first phase of evaluation, and several instruments, namely the Vineland Adaptive Behavior Scale, a school adjustment questionnaire, school readiness questionnaire and goal attainment scale, were used during the second phase to evaluate the outcomes of the intervention plan. Both quantitative and qualitative data revealed that all participating children’s attainment of school readiness goals improved, but their specific disabilities and learning environments should be considered. The study emphasizes family involvement and collaboration with transdisciplinary professionals as fundamental to transition practices in promoting children’s learning outcomes.
Preface and Acknowledgements
This is the first text book that is prepared as a joint work between four Arab countries including Egypt, Jordan, Lebanon and Syria (in alphabetical order) which seeks to present and integrate relevant information related to the field of infant and young child feeding. It is prepared for individuals who wish to specialize in the field of lactation management for promoting, supporting and protecting breastfeeding and continued support of infant
feeding in the first five years of life. It is intended for use by countries in different regions of the world with a focus of developing countries and countries where breastfeeding is mandatory for saving lives and achieving the Sustainable Development Goals.
This book was prepared in three phases, the first phase was done between the main authors, in the second phase a team from Egypt and a team from Lebanon reviewed and edited the chapters, in the third phase the book was again reviewed and finalized by the main authors. It is divided into 22 chapters that cover the academic, clinical,
nutritional and critical management procedures necessary for nutritionists, physicians, health providers to support mothers at different levels of care and in different chronological periods of child development from conception to five years of age and is centered around the needs of both the mother, the baby and the family and community at large for promoting, supporting and protecting breastfeeding. It is tailored to the needs of
specialists globally, but especially for those from the developing countries. This book would not have been made possible without the bulk of authentic and growing literature updates and research work, from all over the world, that was accessed online.
We are sincerely grateful to the Nutrition Unit in the Eastern Mediterranean Region (EMRO) for its support in the editing and finalization RI�the book to reach its current state.
We sincerely appreciate the team in Lebanon led by Dr. Maha Hoteit and included: Lactation Specialist Rim El Hajj Sleiman; Ms. Carla Ibrahim, Holy Spirit University of Kaslik (USEK); Ms. Hala Mohsen, Lebanese University, and Ms. Nour Yazbeck, Lebanese University, who dedicated much time and effort in this work.
We are also grateful to the team who assisted Dr. Azza Abul-Fadl from Egypt who included Professor Salah Ali Ismail Ali, Sohag University; Dr. Ahmed Alsaed Younes, Head of EPA and ESBMF; the team from Benha Univeristy including Professor AlRawhaa Abuamer and Dr. Ranya Abdelatty from Benha Faculty of Medicine, and the team
from Alexandria University; Professor Nadia Farghaly, Faculty of Medicine, Dr. Ahlam Mahmoud and Dr. Eman Kaluibi, Faculty of Nursing and the team from MCFC including Dr. Shorouk Haithamy and Dr. Samaah Zohair and Organizational psychologist Ms. Iman Sarhan from Newcastle University. This has been an intense and invigorating experience especially with the feedback received from Syria by Dr. Mahmoud Bozo who participated
in the activity despite the difficult circumstances in Syria. We are grateful to Dr. Moataz Saleh, Nutrition Specialist and Dr. Naglaa Arafa, Nutrition officer from UNICEF, Cairo office for their technical support. Indeed this work would not have been made possible without the coordinating efforts of Dr Ms. Nashwa Nasr from WHO-EMRO.
We received support from the administrators, designers and information technologists and many other experts who supported this work and to whom we are also very grateful.
Last but not least we owe this work to the spiritual support of mothers struggling to breastfeed their babies who have inspired us throughout this work and we hope our efforts will reach out to them and to all those who are encouraging, guiding and supporting them in their exceptionally unique motherhood experience. We commend
and applaud the many scientists, research workers and authors of books in this field and are grateful to those who delivered libraries to our homes by the internet. We sincerely hope that this material as a publication or an e-book will be a match of their work and meet the needs of a large spectrum of readers, learners and scientists who wish to expand their knowledge in this field. We look forward to expanding this work and making it available in different languages and welcome those who can assist us to accomplish this
Background: This practical implementation report describes a primary care-based group parenting intervention—Child–Adult Relationship Enhancement in Primary Care (PriCARE)—and the approach taken to understand and strengthen the referral process for PriCARE within a pediatric primary care clinic through the deployment of synergistic implementation strategies to promote physician referrals. PriCARE has evidence of effectiveness for reducing child behavior problems, harsh and permissive parenting, and parent stress from three randomized controlled trials (RCTs). The integration of evidence-based parenting interventions into pediatric primary care is a promising means for widespread dissemination. Yet, even when integrated into this setting, the true reach will depend on parents knowing about and attending the intervention. A key factor in this process is the endorsement of and referral to the intervention by the child's pediatrician. Therefore, identifying strategies to improve physician referrals to parenting interventions embedded in primary care is worthy of investigation. Method: Through lessons learned from the RCTs and key informant interviews with stakeholders, we identified barriers and facilitators to physician referrals of eligible parent–child dyads to PriCARE. Based on this data, we selected and implemented five strategies to increase the PriCARE referral rate. We outline the selection process, the postulated synergistic interactions, and the results of these efforts. Conclusions: The following five discrete strategies were implemented: physician reminders, direct advertising to patients, incentives/public recognition, interpersonal patient narratives, and audit and feedback. These discrete strategies were synergistically combined to create a multifaceted approach to improve physician referrals. Following implementation, referrals increased from 13% to 55%. Continued development, application, and evaluation of implementation strategies to promote the uptake of evidence-based parenting interventions into general use in the primary care setting are discussed.
Plain Language Summary
There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.
Background:
Maternal depression was an increasing risk of child neurodevelopment difficulties. However, maternal depression was always chronic and recurrent, and few studies have explored the association between the severity and duration of maternal depression and child development. We aimed to explore the relationship between trajectories of maternal depressive symptoms from pregnancy to the first six months postpartum and child development at eight months.
Methods:
Data was collected from 988 mother-child pairs who participated in Shenzhen Birth Cohort Study. Maternal depressive symptoms were evaluated by the Edinburgh Postnatal Depression Scale (EPDS) at four points: late pregnancy, 1 month, 3 months, and 6 months postpartum. Child emotional and behavioral developments were assessed by Ages and Stages Questionnaires: Social-Emotional (ASQ-SE) and Ages and Stages Questionnaires-Third Edition (ASQ-3) at 8 months postpartum. Latent profile class analysis (LPA) was used to identify the trajectories of maternal depressive symptoms. Univariate and multivariate linear regression were conducted to explore the association between the depressive symptoms trajectories and child development.
Results:
Four trajectories of maternal depressive symptoms were identified by LPA: low(n=605), subclinical(n=93), moderate-low and increasing(n=255) and persistent high (54). Multivariable regressions showed that children of mothers assigned to persistent high depressive symptoms were more likely to have low scores in ASQ-3 total, three ASQ-3 domains (fine, problem-solving, and personal-society motor) and ASQ-se. Children of mothers assigned to class2 were more likely to have lower scores in ASQ-3 total, two ASQ-3 domains (communication motor and gross motor) and ASQ-se, compared to children of mothers assigned to class1. Risk factors identified in the multi-model included low birth weight, sleep quality at late pregnancy, low education level, and breastfeeding at 3month.
Conclusion:
The impact of high levels of maternal depression symptoms on the increased risk of child developmental delay highlights the importance of early intervention and addressing maternal depression from pregnancy through early childhood. These findings draw attention to the need to move beyond a “depressed/not depressed” approach to screening for depression in the perinatal period.
Maternal internalizing symptoms have been linked with child internalizing symptoms, but paternal internalizing difficulties have received little attention. Our aims were to prospectively analyse the simultaneous effect of maternal and paternal internalizing symptoms on child internalizing difficulties, examining gender differences, and to verify the mediating effect of parenting practices and child irritability. The sample included 470 families assessed at child ages 3, 6, 8, and 11. Multi-group structural equation modelling was performed with Mplus8.2. Complete equivalence was found between boys and girls for all paths. Maternal internalizing symptoms at age 3 had an indirect effect on child internalizing symptoms at age 11, via irritability at age 8. Paternal internalizing symptoms at age 3 were not associated with any of the variables under study. Maternal internalizing symptoms and child irritability are targets for intervention in order to prevent child internalizing difficulties.
Potential bidirectional associations between preschool classroom overactive (or externalizing) and underactive (or internalizing) behaviors and language and literacy skills (i.e., vocabulary and listening comprehension) were examined in a sample of children enrolled in Head Start ( N = 297). Cross-lagged panel designs using structural equation modeling (SEM) were conducted using data gathered through teacher ratings and direct assessments developed for use in preschool programs serving diverse populations of young children. Significant associations varied by type of behavior and language and literacy skill. Higher overactive behavior in the fall was associated with lower listening comprehension skills in the spring, whereas higher underactive behavior in the fall was associated with lower vocabulary skills in the spring. In addition, lower listening comprehension skills in the fall were associated with higher levels of underactive behavior in the spring. Implications for future research, policy, and practice are discussed.
The current study examined the feasibility and initial efficacy of the Summer Treatment Program for Pre-kindergarteners (STP-PreK) with 37 preschoolers with autism spectrum disorder (ASD) and externalizing behavior problems (EBP). Parents and teachers reported on children’s behavior, social/adaptive skills, and self-regulation. Children completed a standardized achievement and executive functioning battery and an emotion knowledge task. The treatment was delivered with high levels of fidelity and was well received by families. Improvements were reported in parent-rated hyperactivity, inattention, aggression, and social and adaptive skills. Children also improved performance across academic achievement, emotion knowledge, and executive functioning and were rated by parents as having better executive functioning and emotion regulation. Findings highlight the initial efficacy of an established treatment in improving outcomes for preschoolers with ASD and EBP.
Research Findings
Universal screening practices that utilize reliable and valid screening measures are vital for identifying social-emotional and behavioral (SEB) concerns for students at-risk for future behavioral and academic difficulties. Screening procedures implemented at the start of kindergarten can result in early identification and intervention for students with SEB difficulties. However, few studies have systematically identified and reviewed screeners of SEB constructs of kindergarten readiness. The current study systematically identified and reviewed the psychometric properties of 11 rating scales that may be used as screeners of SEB difficulties at kindergarten entry in the United States. In addition, this study evaluated bias identification methods to determine the extent to which scales may be used with diverse populations. Results of this study demonstrated adequate to strong reliability evidence and inadequate validity and bias evaluation evidence. Practice or Policy: Results of this study can be used by school personnel as they work to identify universal screening rating scales that are most appropriate in their setting. In addition, this study identified significant gaps in the current landscape of SEB assessments for universal screening measures that may be addressed through future research efforts.
The use of brief rating forms completed by caregivers to identify children at-risk for developing behavioral disorders is common (Lane et al., 2009). However, identifying a behavioral measure assessing child-level variables (i.e., temperamental traits) which predict later behavioral concerns has potential to improve universal screening practices in the context of a multi-tiered systems of support (MTSS) framework. Self-regulation (Rothbart & Bates, 2006) is a trait that is related to externalizing problem behaviors (e.g., Espy et al., 2011), and may be useful as a means to predict young children at risk for developing behavioral disorders. The purpose of this study is to explore the predictive validity of an established measure of self-regulation (the Head-Toes-Knees-Shoulders Task; HTKS; McClelland & Cameron, 2012), for clinically elevated externalizing behaviors (identified using clinical rating forms of externalizing behavior). It was hypothesized that assessing a stable, individual trait such as self-regulation could allow for even earlier identification and intervention among at-risk children than may be available with present screening methods. Participants were 24 preschool students and their classroom teachers. The students were administered the HTKS in their schools and their teachers each completed a rating form assessing behavioral problems across three measures (i.e., the Social Skills Improvement System, Achenbach Caregiver-Teacher Report Form, and Conners Early Childhood Behavior Scale). Surprisingly, this study did not replicate the relationships between self-regulation and behavioral concerns. Correlations between variables suggested positive relationships between the HTKS and two of the behavioral measures (i.e., opposite of the hypothesized direction). Multiple linear regression analyses exploring the relationship between continuous criterion and predictor variables were unable to reject the null hypothesis that HTKS does not predict behavioral concerns. Further, logistic regression analyses exploring a dichotomous criterion (i.e., the presence or absence of clinically-elevated behavioral problems) also failed to reject the null hypothesis of the model discriminating behavior problem status no better than chance. Follow-up Receiver Operating Characteristics (ROC) curves and comparison of the area-under-the-ROC-curve (AUC) further suggested HTKS was not an effective tool for screening in this context. Finally, the study explores its limitations and proposes additional questions for future research. Advisor: Susan M. Sheridan
Objective: Asthma is a risk factor for poor early reading in children, for reasons that are unclear. This analysis examines the relationship between changes in asthma severity during the first year of school and being in the lowest quartile of reading achievement after 1 year of school.
Methods: We used previously unreported data from our cohort study. Parent interviews and teacher questionnaires enquired about asthma and covariates of achievement at school entry (T1) and 12 months later (T2). Asthma severity scores at T1 and T2 showed that in 27 of 51 children with asthma, symptoms improved over the year, whereas in 24, symptoms persisted or worsened. Word and story reading were assessed at T1 and T2. We compared reading achievement at both timepoints between children with asthma and children who had no reported respiratory symptoms between birth and T2 (controls, N = 74), and between those with persistent versus improved symptoms.
Results: More children with asthma than controls were in the lowest quartiles for reading. Further, significantly more children in the persistent group compared to the improved group were in the lowest quartiles for word reading (58 versus 30%, respectively) and story reading (54 versus 26%, respectively). School absences, increased behavior problems, stressful life events or parental mental health were not associated with the differences in either comparison. Logistic regression modeling identified persistent asthma as the most important variable associated with being in the lowest quartile of reading after 1 year in school.
Conclusions: Active asthma symptoms during early school may influence early reading achievement.
Preschoolers with attention-deficit hyperactivity disorder or disruptive behavior disorder often lack school readiness skills and may be at risk for subsequent poor academic achievement, which affects their long-term health and well-being. This article describes the challenges to affected families and children, reviews the diagnostic process in primary care, and offers evidence-based management options including behavior management training and/or the use of stimulant medications.
Objective:
Child Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group parent training designed to teach positive parenting skills. Our objective was to measure PriCARE's impact on child behavior and parenting attitudes.
Methods:
Parents of children 2 to 6 years old with behavior concerns were randomized to PriCARE (n=80) or control (n=40). Child behavior and parenting attitudes were measured at baseline (0 weeks), program completion (9 weeks), and 7 weeks following program completion (16 weeks) using the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory-2 (AAPI2). Linear regression models compared mean ECBI and AAPI2 change scores from 0 to 16 weeks in the PriCARE and control groups, adjusted for baseline scores.
Results:
Of those randomized to PriCARE, 43% attended 3 or more sessions. Decreases in mean ECBI intensity and problem scores between 0 and 16 weeks were greater in the PriCARE group, reflecting a larger improvement in behavior problems [intensity: -22 (-16, -29) vs -7 (2, -17), p=0.012; problem: -5 (-4, -7) vs -2 (0, -4), p=0.014]. Scores on 3 of the 5 AAPI2 sub-scales reflected greater improvements in parenting attitudes in the PriCARE group compared to control in the following areas: empathy towards children's needs [0.82 (1.14, 0.51) vs 0.25 (0.70, -0.19), p=0.04], corporal punishment [0.22 (0.45, 0.00) vs -0.30 (0.02, -0.61), p=0.009], and power and independence [0.37 (0.76, -0.02) vs -0.64 (-0.09, -1.19), p=0.003].
Conclusions:
PriCARE shows promise in improving parent-reported child-behavior problems in preschool-aged children and increasing positive parenting attitudes.
Objective:
To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health.
Sources:
A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child.
Summary of the findings:
With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a 'school readiness' checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential.
Conclusions:
The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.
In New Zealand, children facing developmental or behavioural difficulties are largely reliant on referral to Special Education by a parent, educator, or psychologist. A different way to identify problems may be to screen for them at school entry. We compared the efficacy of assessments of children's physical and language skills, readiness for reading, behavioural and conduct difficulties in identifying children who had previously been referred to Special Education. We found that assessing children's gross motor skills was the most successful way of identifying children who had already been referred to Special Education, especially when followed by either an assessment of pre-reading skills (Concepts About Print: CAP) or the Strengths and Difficulties Questionnaire (SDQ), which are both routinely administered to new entrant or preschool children in New Zealand.
School readiness and educational success is strongly mediated by early literacy skills. In both exam-room and community-based settings, child-health providers can affect the trajectory of early literacy by implementing evidence-based, culturally appropriate interventions that support child development, parenting skills, and child-caregiver interaction. Despite limited research on the subject, these interventions should also attend to the evolving role of digital-media exposure (both positive and negative) on the developmental health of children.
Copyright © 2015 Elsevier Inc. All rights reserved.
The motor and language skills, emotional and behavioural problems of 245
children were measured at school entry. Fine motor scores were significantly
predicted by hyperactivity, phonetic awareness, prosocial behaviour, and the
presence of medical problems. Gross motor scores were significantly predicted
by the presence of medical problems. The fine motor scores of Ma¯ori children
were poorer than those of Pa¯ keka¯ or children of other ethnicities, and righthanded
children had better fine motor scores than left-handed children. There
was some evidence that left-handed boys performed particularly poorly on
tasks requiring fine motor skills. Children with medical problems had poorer
gross motor scores than children without medical problems. Implications for
the identification of problems at school entry are discussed.
Abstract A case of pediatric oppositional defiant disorder (ODD) with concomitant emotional dysregulation and secondary behavioral disruptiveness was treated with hypnosis by means of the hypnotic hold, a method adapted by the authors. An A-B-A-B time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of emotional dysregulation with accompanying behavioral disruptiveness. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Follow-up at 6 months indicated a significant reduction of the frequency of targeted episodes of emotional dysregulation and behavioral disruptiveness at home.
The propensity score is the conditional probability of assignment to a particular treatment given a vector of observed covariates. Both large and small sample theory show that adjustment for the scalar propensity score is sufficient to remove bias due to all observed covariates. Applications include: (i) matched sampling on the univariate propensity score, which is a generalization of discriminant matching, (ii) multivariate adjustment by subclassification on the propensity score where the same subclasses are used to estimate treatment effects for all outcome variables and in all subpopulations, and (iii) visual representation of multivariate covariance adjustment by a two- dimensional plot.
The propensity score is the conditional probability of assignment to a particular treatment given a vector of observed covariates. Previous theoretical arguments have shown that subclassification on the propensity score will balance all observed covariates. Subclassification on an estimated propensity score is illustrated, using observational data on treatments for coronary artery disease. Five subclasses defined by the estimated propensity score are constructed that balance 74 covariates, and thereby provide estimates of treatment effects using direct adjustment. These subclasses are applied within subpopulations, and model-based adjustments are then used to provide estimates of treatment effects within these subpopulations. Two appendixes address theoretical issues related to the application: the effectiveness of subclassification on the propensity score in removing bias, and balancing properties of propensity scores with incomplete data. Statistics Version of Record
Clinic and forensic studies have reported high rates of language impairments in conduct disordered and incarcerated youth. In community samples followed to early adolescence, speech and language impairments have been linked to attention deficits and internalizing problems, rather than conduct problems, delinquency, or aggression. This study examines the young adult antisocial outcomes of speech or language impaired children. Language impaired boys had higher levels of parent-rated delinquency symptoms by age 19 than boys without language impairment, controlled for verbal IQ and for demographic and family variables. Language impaired boys did not differ from controls in self-reported delinquency or aggression symptoms on a standardized checklist; however, language impaired boys reported higher rates of arrests and convictions than controls. Language impairment was not related to aggression or delinquency in girls. We examine alternate models of the interrelationships between language, academics, and behavior, at ages 5, 12, and 19.
School readiness includes the readiness of the individual child, the school's readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to be ready for all children at all levels of readiness. Children's readiness for kindergarten should become an outcome measure for community-based programs, rather than an exclusion criterion at the beginning of the formal educational experience. Our new knowledge of early brain and child development has revealed that modifiable factors in a child's early experience can greatly affect that child's learning trajectory. Many US children enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification of and attention to child and family needs. Pediatricians have a role in promoting school readiness for all children, beginning at birth, through their practices and advocacy. The American Academy of Pediatrics affords pediatricians many opportunities to promote the physical, social-emotional, and educational health of young children, with other advocacy groups. This technical report supports American Academy of Pediatrics policy statements "Quality Early Education and Child Care From Birth to Kindergarten" and "The Inappropriate Use of School 'Readiness' Tests."
Rates and predictors of preschool expulsion and suspension were examined in a randomly selected sample of Massachusetts preschool teachers (N = 119). During a 12-month period, 39% of teachers reported expelling at least one child, and 15% reported suspending. The preschool expulsion rate was 27.42 per 1000 enrollees, more than 34 times the Massachusetts K-12 rate and more than 13 times the national K-12 rate. Suspension rates for preschoolers were less than that for K-12. Larger classes, higher proportion of 3-year-olds in the class, and elevated teacher job stress predicted increased likelihood of expulsion. Location in a school or Head Start and teachers' positive feelings of job satisfaction predicted decreased likelihood of expulsion. Expulsion was relatively rare in classes where both class size and teacher job stress were low. A higher proportion of Latino children in the class and lower teacher job satisfaction predicted an increased likelihood of suspension. Implications are discussed regarding policy, prevention, and future research.
The propensity score is the conditional probability of assignment to a particular treatment given a vector of observed covariates. Both large and small sample theory show that adjustment for the scalar propensity score is sufficient to remove bias due to all observed covariates. Applications include: (i) matched sampling on the univariate propensity score, which is a generalization of discriminant matching, (ii) multivariate adjustment by subclassification on the propensity score where the same subclasses are used to estimate treatment effects for all outcome variables and in all subpopulations, and (iii) visual representation of multivariate covariance adjustment by a two-dimensional plot.
To examine the association between early childhood speech and language disorders and young adult psychiatric disorders.
In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome.
Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one.
Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.
Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated.
To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma.
A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes.
Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8).
Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.
Rapidly advancing research in neurobiology and the behavioral and social sciences, coupled with dramatic changes in the social and economic circumstances under which families are raising young children, has created a highly dynamic context for early childhood policy, service delivery, and child rearing in the United States. A recent report from the National Research Council and the Institute of Medicine, presents a critical analysis of that complex knowledge base and a set of recommendations designed to close the gap between what we know and what we do to promote the healthy development of young children. This article examines the report through the lens of developmental and behavioral pediatrics and highlights both exciting opportunities and sobering challenges.
For more than 30 years, pediatrics has embraced early child development and school performance at older ages as an integral part of clinical practice. This growing focus on child development and school performance outcomes was informed in part by the changing epidemiology of children’s health, the related reframing of the scope of pediatric practice under the construct of “new morbidities,” and the influential 1987 report from the Task Force on Pediatric Education.1,2 Child development has become a certified subspecialty, and residency programs have specified training requirements. Despite significant progress, even more needs to be done not only to identify children with developmental disabilities and institute appropriate and timely interventions, but also to promote optimal development and enhance the school readiness of all children.3
Our current understanding of the importance of early childhood is converging with our national policy agenda to improve educational opportunities and outcomes for all children. The convergence of these 2 trends is taking place under the banner of school readiness, referring both to a child’s capacity to learn, grow, and achieve and also creating an organizing principle and outcome for major statewide early childhood initiatives throughout the United States. As a result, pediatricians will increasingly be called on to direct more of their clinical expertise in service of this important societal goal, and are likely to find themselves, as many other early childhood professionals and teachers are, increasingly involved in the “school readiness business.” Underlying these observable changes in social policy are tectonic shifts in our understanding of the importance of early childhood and the role of school readiness in promoting not only academic achievement but longer term health outcomes.
Whereas before 1990 the term school readiness was used to evaluate and some would say to label children who were not “mature enough” …
The authors' goal was to test the hypothesis that DSM-IV symptoms of oppositional defiant disorder and conduct disorder can be validly applied to preschoolers.
Using a semistructured diagnostic interview, they assessed rates of symptoms of DSM-IV oppositional defiant and conduct disorders in 2.5-5.5-year-old children who were referred to a psychiatry clinic and a comparison group of nonreferred children.
Clinically referred preschool children had significantly higher rates of oppositional defiant and conduct disorder symptoms than nonreferred children. Among nonreferred preschoolers, rates of all oppositional defiant and conduct disorder symptoms were at or below 8%.
DSM-IV symptoms of oppositional defiant and conduct disorders distinguish referred from nonreferred preschool children in a pattern consistent with that seen in older children. Preschool children who are not seeking mental health services do not have high rates of disruptive behavior problems. The DSM-IV nosology appears to be a valid diagnostic system for discriminating between typical and atypical disruptive behaviors in preschool children.
Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This report addresses a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play. This report offers guidelines on how pediatricians can advocate for children by helping families, school systems, and communities consider how best to ensure that play is protected as they seek the balance in children's lives to create the optimal developmental milieu.
Studies suggest that having a child with autism has a negative impact on maternal psychological functioning, but no large-scale, population-based studies are available. The objectives of this study were to (1) describe the psychological functioning, physical and mental health, family communication, and parenting support of mothers of a child with autism compared with other mothers on a population basis and (2) assess the independent relationship between having a child with autism and these outcomes, controlling for the child's social skills and demographic background.
Mothers of 61,772 children who were 4 to 17 years of age were surveyed by the National Survey of Children's Health, 2003. Autism was measured from an affirmative maternal response to the question, "Has a doctor or health professional ever told you your child has autism?" There were 364 children with autism in the sample.
Mothers of a child with autism were highly stressed and more likely to report poor or fair mental health than mothers in the general population, even after adjustment for the child's social skills and demographic background. However, mothers of a child with autism were more likely to report a close relationship and better coping with parenting tasks and less likely to report being angry with their child after adjustment for the child's social skills and demographic background. Having a child with autism was not associated with lower social support for parenting, an altered manner in which serious disagreements were discussed in the household, or increased violence in the household.
Mothers of children with autism showed remarkable strengths in the parent-child relationship, social support, and stability of the household in the context of high stress and poorer mental health.
To study the relationship between experiencing separation from parents and having learning difficulties among children in a community-based sample.
In 2003, parents of children entering kindergarten in the city of Rochester completed a survey assessing the child's social background, medical history, and behavioral profile. Children separated from parents for >1 month were compared with those who had never been away for >1 month on 4 validated developmental measures (range, 1-4): a learning scale, an expressive language scale, a preliteracy scale, and a speech scale. Bivariate analyses and multivariate logistic regression analyses were used to determine associations between separation from parents and learning difficulties.
Among the 1619 children, 18% had been separated from a parent for >1 month at least once (11% once, 7% > or =2 times). Separated children scored worse compared with those without separations on learning (3.14 vs 3.28, P = .001) and preliteracy (2.21 vs 2.35, P = .03). Higher rates of learning difficulties (26.7% vs 16.7%, P < .001) and preliteracy problems (25.9% vs 18.7%, P = .01) were noted among those who had been separated versus those who had not. In multivariable modeling, separation was associated with learning problems (adjusted odds ratio, 1.71; 95% confidence interval, 1.18-2.49) and preliteracy problems (adjusted odds ratio, 1.46; 95% confidence interval, 1.04-2.05) when adjusted for demographic, medical, and social factors.
Urban children who have experienced separation from a parent may have more learning difficulties at entrance to kindergarten. Screening and intervention practices to remedy these challenges may better equip such young children to succeed when they enter school.
The impact of childhood autism on parental employment is largely unknown.
The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems. METHODS. Parents of 16282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, "Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?" There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used chi(2) and multivariate logistic regression analyses.
Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty.
Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.
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