[Development and standardisation of the social-pediatric screening SOPESS]

[Early childhood intervention and children's health development : Exemplary findings and methodological challenges in the use of the school entry examination]

BACKGROUND

Early childhood intervention is intended to systematically network and customise support services, particularly for socio-economically disadvantaged families. The programmes are universal or selective, but the evidence on their effectiveness is limited.

AIMS

The aims of this study were to exemplary analyse whether participants in early childhood intervention services had better development than non-participants using the school entry examination (SEE) as well as to discuss to what extent the SEE can be used to assess the impact of early childhood intervention services.

METHODS

We analysed three typical offers of early childhood intervention services (family education; Zukunft für Kinder (ZfK); Kita-U) in relation to full vaccination coverage and age-appropriate development at U9. Data from 4579 Düsseldorf first graders were included. Propensity score matching was used to calculate percentage differences (average treatment effect on the treated; ATT) in terms of immunisation coverage and development between comparable intervention and control groups.

RESULTS

All programmes are associated with a slightly increased probability of full vaccination protection (ATT 2.1 for family education; 2.5 for ZfK; 5.3 for Kita-U). Family education is also associated with a slightly higher probability of age-appropriate development (ATT 1.6), while the probability of age-appropriate development is lower for participants in ZfK (-10.1) and Kita‑U (-4.5).

DISCUSSION

The evaluation of early childhood intervention, especially selective services, is a methodological challenge due to confounding and suitable comparison groups. However, the SEE could be a framework for impact analyses under specific conditions.

Child Motor Development before and after the COVID-19 Pandemic: Are There Social Inequalities?

BACKGROUND

COVID-19 pandemic has influenced all children's motor development. We examine whether this differs by social circumstances. We hypothesise that socially disadvantaged children experienced more pronounced motor problems compared with better-off children.

METHODS

Our trend study includes three representative waves of preschoolers (school years 2018/19, 2019/20, 2023/24) from a German school enrolment medical screening. Based on logistic regressions, we computed predicted prevalences of motor problems separately for children in different social circumstances (neighbourhood, migration background, family status).

RESULTS

Motor development of preschoolers slightly worsened by 2023 compared to pre-pandemic level (6.3 percent 2018 to 7.4 percent 2023). Results by neighbourhood highlight that preschoolers from well-off districts experienced a deterioration of motor development (4.9 percent 2018-6.4 percent 2023). The prevalence of motor problems is, however, below that of children from deprived neighbourhoods with consistently high prevalence (9.2-10 percent). Results by migration background show a worsening trend for children without migration background and the gap between the groups disappears in 2023. Results by family status do not indicate significant differences.

CONCLUSION

Contrary to our hypothesis, socially disadvantaged children experienced smaller change in motor problems. However, our results highlight the potential of structured physical activities in daycare centres and sports facilities to enhance the motor development of these children.

Social inequalities in early childhood language development during the COVID-19 pandemic: a descriptive study with data from three consecutive school entry surveys in Germany

BACKGROUND

Social health inequalities are still of great public health importance in modern societies. The COVID-19 pandemic may have affected social inequalities in people's health due to containment measures. As these measures particularly affected children, they might have been particularly vulnerable to increased social inequalities. The aim of the study was to describe health inequalities during the pandemic based on language delay (LD) in children in order to inform public health interventions for a population at risk of long-term health and education inequalities.

METHODS

Data of 5-7 year old children from three consecutive school entry surveys in the German federal state of Brandenburg were used, including data compulsorily collected before the pandemic (2018/2019: n = 19,299), at the beginning of the pandemic (2019/2020: n = 19,916) and during the pandemic (2020/2021: n = 19,698). Bivariate and multivariate binary regression analyses [OR, 95% CI] cross-sectionally examined the relationship between the prevalence of LD [yes/no] and social inequalities, operationalized by family socioeconomic position [SEP low/middle/high], migration background [native-German language/non-native German language] and length of kindergarten attendance [< 4 years/ ≥ 4 years]. Factors contributing to inequality in LD were examined by socioeconomic stratification.

RESULTS

Cross-sectionally, LD prevalence has decreased overall (2018/2019: 21.1%, 2019/2020: 19.2%, 2020/2021: 18.8%), and among children from both high SEP and native German-speaking families. As LD prevalence increased among children from families with low SEP and remained stable among non-native German speakers, social inequalities in LD prevalence increased slightly during the pandemic i) by low SEP (2018/2019: OR = 4.41, 3.93-4.94; 2020/2021: OR = 5.12, 4.54-5.77) and ii) by non-German native language (2018/2019: OR = 2.22, 1.86-2.66; 2020/2021: OR = 2.54, 2.19-2.95). During the pandemic, both migration background and kindergarten attendance determined LD prevalence in the high and middle SEP strata. However, the measured factors did not contribute to LD prevalence in children from families with low SEP.

CONCLUSION

Social inequalities in LD increased due to opposing trends in prevalence comparing low and high SEP families. To promote health equity across the life course, early childhood should be of interest for tailored public health actions (e.g. through targeted interventions for kindergarten groups). Further analytical studies should investigate determinants (e.g., parental investment).

[How is The School Entrance Examination Carried Out in Germany? A Nationwide Survey of the German Public Health Departments.]

OBJECTIVE

The aim of this study was to give an overview of the content, procedure and diagnostic methods used for the school entrance examination (SEE) in Germany. The focus was on the general implementation of the SEE and the developmental screening methods in the individual federal states of Germany.

METHOD

A total of 183 employees from the public health authorities from 15 different states took part in an online survey.

RESULTS

The results showed a very heterogeneous picture with regard to the SEE, with the information provided by the employees varying both between and within most states. However, most frequently the SEE was carried out by physicians from the public health service within one examination (single stage), took 46 to 60 minutes per child, and administered not earlier than 12 months before school entrance. In terms of content, the focus was on the physical and cognitive development of the children. Most employees of the health authorities reported that they had specific requirements from the state or municipality for the implementation of the SEE. The Social Pediatric Screening of Developmental Status for School Entry (SOPESS) was the screening instrument used most often. In addition, it was reported that the majority of screenings lasted between 16 to 30 minutes, were executed completely and carried out in the same order. In around 50-60% of the cases, it was assumed that the screenings used met the scientific quality criteria.

CONCLUSIONS

The present study offers an opportunity to compare the different approaches to the implementation of the SEE and to suggest further developments.

[Ready for school? An analysis of the developmental screening used as part of the school entrance examination in Germany]

The School Entrance Examination (SEE) provides important information about the educational needs of pre-school children and for health reporting. The SEE should reflect the latest scientific knowledge and generate high-quality data. To do this, it must meet scientific quality criteria and be continuously evaluated and further developed. Regarding the high relevance of the data and the enormous resources needed to test all pre-school children, the SEE must face a scientific and public debate with regard to its usefulness, content and structure. This requires a transparent communication and publication practice. The aim of this overview article was to summarize the publicly available information on the developmental screening incorporated in the SEE in the different federal states of Germany and to evaluate it in terms of transparency, completeness and scientific quality. While the assessed abilities were very similar, there were major differences in the timing of the SEE, whether a one- or multi-stage procedure was used and the extent to which all children were examined by physicians from the public health service. SOPESS is the most frequently used developmental screening method in Germany, for which sufficient quality criteria have been identified. For some of the other widely used methods, validation and standardization were found to be lacking. Overall, there is little publicly available information or scientific publications on the SEE. The heterogeneity of the procedures used in Germany can be seen as an opportunity for the further development and improvement of the SEE. Continuous communication between public health authorities and users as well as thorough scientific monitoring and public debate would be desirable in this context.

Child health and development in the course of the COVID-19 pandemic: are there social inequalities?

COVID-19 pandemic lockdowns and closures have influenced all children's health and development (HAD). We aimed to examine whether this differs by social circumstances. We hypothesised that socially disadvantaged children experienced more pronounced deterioration in their HAD compared with better-off children. In our trend study, we included five cohorts of school enrolment medical screening (school entrance 2018-2022) in the city of Dusseldorf, Germany. To compensate for selection bias due to the limited number of examinations in pandemic months, we chose the first 800 examinations of each cohort. We computed predicted prevalences of overweight, coordination and language problems as indicators of HAD. Neighbourhood deprivation, single-parent families and non-German nationality were used as indicators of social disadvantage. All groups of children experienced a deterioration in their HAD. Its magnitude is comparable between children with different social circumstances. For instance, between 2018 and 2021, prevalence of overweight increased from 19.2 to 24.2% in children from deprived neighbourhoods, and from 8.1 to 16.5% in children from well-off neighbourhoods. Prevalence of language problems (prepositions) increased from 49.9 to 72.1% among non-German children, and from 14.4 to 39.1% among German children.   Conclusion: Results only partly confirmed our hypothesis. However, since the pre-pandemic prevalences of HAD problems among disadvantaged children were already higher, further deterioration - regardless of its magnitude - has led to their particularly poor situation. For those children, overweight and language development should be priorities of prevention. Generally, important settings for child HAD such as kindergartens or leisure facilities should remain open in future pandemics. What is known: • The COVID-19 pandemic has had a negative impact on general child health and development. • Before the pandemic, social inequalities in child health and development were a common phenomenon. What is new: • Children in all social groups experienced a deterioration in their health and development over the course of the pandemic. • Over the course of the pandemic, children from deprived neighbourhoods have demonstrated a particularly high prevalence of overweight. Language problems are particularly prevalent among non-German children.

Die Kindergartenuntersuchung: eine Bestandsaufnahme zur Umsetzung in Deutschland

Hintergrund

Um die Entwicklung der Kinder möglichst früh einschätzen und fördern zu können, gewinnen Kindergartenuntersuchungen an Bedeutung. Sie werden jedoch nicht flächendeckend durchgeführt und es gibt keinen Überblick über die verschiedenen Verfahren.

Fragestellung

Ziel der Arbeit war es, herauszuarbeiten, wie Kindergartenuntersuchungen in Deutschland umgesetzt werden.

Material und Methoden

Es wurden eine Überblicksrecherche und eine systematische Literaturrecherche sowie problemzentrierte Interviews (n = 8) mit relevanten Akteurinnen und Akteuren durchgeführt, die durch die vorangestellten Recherchen identifiziert worden waren.

Ergebnisse

Es existiert eine Vielzahl an Begriffen und Instrumenten, gesetzlichen Grundlagen, kommunalen Kooperationsformen und Verfahrensweisen mit den Ergebnissen. Kindergartenuntersuchungen sind meist in ein Gesamtkonzept eingebettet, mit dem Eltern ins Fördersystem vermittelt werden.

Schlussfolgerung

Das Zusammenspiel wissenschaftlicher Auseinandersetzung, gesetzlicher Legimitation und fachlichen Austausches kann helfen, die Kindergartenuntersuchungen zu stärken und die kindliche Entwicklung frühzeitig zu beurteilen.

Is the Level of Motor Development at School Entry Related to the Use of Municipal Exercise Programs? A Social-Differential Analysis

Children's motor development is socially unevenly distributed despite many municipal exercise programs (EXP). It has not been sufficiently investigated whether and how they appeal to children from different social backgrounds. This study investigates the use of municipal EXP in preschool age and the association between participation and motor development considering social circumstances. In school entry health examinations, parents were asked about participating in various EXP (response = 65.5%; n = 6480). Motor development, i.e., body coordination and visual-motor coordination, were assessed by a social pediatric development screening, and social circumstances by migration background (MB) and parental education (PE). Poisson regression estimated adjusted Incidence Rate Ratios (IRR; 95% confidence interval, 95%-CI) for relationships between social circumstances and participation in programs and participation and body coordination/visual-motor coordination. Children with MB (IRR 0.73; 95%-CI 0.71-0.75) and low PE (IRR 0.45; 95%-CI 0.40-0.50) used EXP less often. Children participating less often have a finding in body- (IRR 0.76; 95%-CI 0.63-0.90) and visual-motor coordination (IRR 0.47; 95%-CI 0.35-0.62). Significant effects were found for children with and without MB and higher PE. Municipalities should make EXP more attractive for families with MB and low PE.

[Child health in the COVID-19 pandemic: results from school entry data and a parent survey in the Hanover region]

Einleitung

Die COVID-19-Pandemie und die damit verbundenen Kontaktbeschränkungen können für Kinder und Jugendliche besonders belastend sein. Die in Deutschland regulär durchgeführten Schuleingangsuntersuchungen liefern Daten zur Entwicklung und Gesundheit von Vorschulkindern und können Hinweise auf die Auswirkungen der Pandemie geben.

Methodik

Anhand der Schuleingangsdaten der Region Hannover wird überprüft, ob nach dem ersten Lockdown 2020 häufiger Entwicklungsauffälligkeiten und Gesundheitsbeeinträchtigungen auftraten als vor der Pandemie. Die Prävalenzen zu den Schuleingangsergebnissen der Einschulungsjahrgänge 2017/2018 bis 2020/2021 werden verglichen. Die Auswertung einer Elternbefragung gibt zudem Aufschlüsse über den Alltag und das Wohlergehen der Kinder und deren Familien während der Pandemie.

Ergebnisse

Nach dem ersten Lockdown zeigt sich, dass Auffälligkeiten in der Sprachkompetenz, der Sprachförderbedarf sowie der Anteil der Kinder, die nur eingeschränkt oder gar kein Deutsch sprechen, deutlicher zugenommen haben als in den Jahren davor. Ferner konnte eine Zunahme von Übergewicht und feinmotorischen Auffälligkeiten sowie ein Anstieg des Medienkonsums festgestellt werden. Die Befragung zeigte, dass der Anteil der Kinder, die häufiger traurig sind, im weiteren Verlauf der Pandemie auf 32,1 % und der Anteil der Kinder, die häufiger Wutanfälle haben, auf 24,9 % angestiegen sind. Kinder haben zunehmend Ein- und Durchschlafprobleme und klagen über Bauch- und Kopfschmerzen, Übelkeit oder Appetitlosigkeit.

Diskussion

Diese Ergebnisse decken sich mit anderen aktuellen Studien und liefern Hinweise auf mögliche Auswirkungen der COVID-19-Pandemie auf die Kindergesundheit. Um hierzu gesicherte Aussagen zu machen, sind jedoch weitere Auswertungen erforderlich.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03446-2) enthalten.

[The School Entrance Examination: Attempted Evaluation by Interviewing Parents, Pediatricians and Schools]

INTRODUCTION

In Germany, school entry examinations (SEU) are mandatory in all (federal) states, the scope and methods of investigation are laid down in state ordinances. The SEUs are performed by the pediatric services (KJGD) of the public health departments. An evaluation of the entire SEU is still pending. Therefore, in 2018, an evaluation of the SEU was carried out in the health department of the city of Frankfurt am Main by interviewing parents, schools and pediatricians.

METHOD

With specifically developed questionnaires, parents as well as administrators of elementary schools and pediatricians were asked about their assessment of and their experiences with the SEU. Certain sentences were to be rated on a 5-point Likert scale. For the evaluation, the positive answers (totally agree / agree) and the negative answers (disagree / strongly disagree) were summarized.

RESULTS

A total of 2,021 parental, 46 school and 37 physician questionnaires were evaluated. The response rate of parents was 90%, that of schools and pediatricians 45% and 56%, respectively and thus significantly worse. Ninety-one percent of parents rated the SEU as useful in addition to their pediatrician check-ups, and 94% considered hearing and vision tests to be particularly important. Eighty-five percent considered the SEU as an important means of undertaking support measures before school entry. Ninety-one percent of school administrators rated the results of the SEU as helpful, 26% of them stated that key areas, including social behavior were given insufficient consideration in the SEU. Many school administrators wanted more support from the health department, e. g. inclusion issues (59%), parenting evening lectures (61%) or general health support (74%). Ninety-one percent of pediatricians also rated the SEU positively. However, misjudgments of the school doctors and uncertainty of the parents as well as rare exchanges/communication were criticized.

CONCLUSION

The overall feedback was positive and the significance of the SEU was not questioned. However, the KJGD should try to better meet the needs of schools for more support and pediatricians' desire for better cooperation. Through a modification of the SEU, capacities could be created for other important tasks of the KJGD, for instance the examination of school newcomers from foreign countries, health promotion in schools, and medical advice to schools.

Psychometric properties and contextual appropriateness of the German version of the Early Development Instrument

BACKGROUND

Assessing the early development of children at a population level in educational settings, may be useful for public health and policy decision making. In this study, we evaluated the psychometric properties and the contextual appropriateness of a German language version of the Early Development Instrument (EDI), a survey-based instrument originally developed in Canada, which assesses developmental vulnerability for children in preschool settings.

METHODS

Sixty preschool teachers from six preschool organizations (22% of organizations contacted) in three cities in southwest Germany participated. They administered a German version of the EDI (GEDI) to 225 children (51% of eligible children). We assessed internal consistency, test-retest and interrater reliability. Preschool teachers assisted in determining face-validity by reviewing item coverage and comprehensibility. Exploratory factor analysis (EFA) was used to evaluate convergent validity. Concurrent validity was measured using correlations and agreements (Bland-Altman plots) between GEDI and other validated instrument scores. Additionally, we compared associations between GEDI domain scores and sociodemographic characteristics with similar associations in EDI studies worldwide.

RESULTS

GEDI domains showed good to excellent internal consistency (0.73 < α > 0.99) and moderate to good test-retest and interrater reliability (0.50 to 0.81 and 0.48 to 0.71, respectively [p-value < 0.05]). Face validity was considered acceptable. EFA showed a factor structure similar to the original EDI. Correlations (range: 0.32 to 0.67) and agreements between GEDI scores and other German language instruments suggested good external reliability. Scoring within the lowest 10th percentile was strongly associated with age.

CONCLUSIONS

Our psychometric assessment suggests good reliability and consistency of the GEDI. Differences in the age distribution of children, pedagogical objectives and educational system features of German preschools require future work to determine score thresholds indicative of vulnerability. Aside from dropping selected items from the original EDI that were inconsistent with features of the German educational system, the distribution of values in the language and cognitive development domain also suggested that context-specific cut-offs must be established for the German version. Such efforts are needed to account for relevant contextual differences between the educational systems.

[Evaluation of the Language-related Domain of the Pediatric Developmental Screening Instrument for Preschool Health Examinations (SOPESS): Results from the Prospective Child Health Survey ikidS]

PURPOSE OF THE STUDY

Developmental delays at school enrollment can affect early educational achievement. Thus, diagnosis and treatment prior to school entry are important. In Germany, SOPESS - a pediatric developmental screening instrument for preschool health examinations (PHE) - was introduced in several federal states. We investigated the relationships between the results of the language-related domain of the SOPESS and later academic language competencies at the end of first grade.

PROCEDURES

Data of the population-based cohort study ikidS (Rhineland Palatinate; Germany) and the PHE provided by public health authorities were linked at individual level. The relationship between the SOPESS-language risk score (range: 0 to 6, higher values indicate more developmental delay) and class teacher-based ratings of academic language competencies (range: -4 to+4, higher values indicate better competencies) was investigated with linear regression models and adjusted for several socio-economic and medical language predictors (e. g. age at school entry, gender, parental education, migration background, hearing disorder). The additional benefits of the SOPESS-language risk score was analyzed using analysis of variance.

RESULTS

In total, 1357 children (48% girls, age at PHE 4.9-7.2 years) were included. A clear negative relationship between the SOPESS-language risk score and competencies in spoken and written language was found. Mean academic language competencies decreased with increasing SOPESS-language risk level from 0.8 (SD=1.7) at a risk score of 0 to-3.2 (SD=0.9) at a risk score of 6. The relationship persisted after adjusting for other language predictors. Analysis of variance showed significant benefits of the SOPESS-language risk score, even when further language predictors were considered.

CONCLUSIONS

There was a clear relationship between results of the SOPESS-language screening and later academic language competencies. Hence, the language-related domain of the SOPESS may be useful for further recommendations of tailored special educational and medical support services, especially if additional socio-economic and medical factors are considered.

[The Brandenburg Network Healthy Children: Early Prevention Shows Effectiveness]

BACKGROUND AND AIM OF THE STUDY

The Brandenburg Network Healthy Children (NHC) is a regional health programme for families with toddlers (0-3) run by trained volunteers. Based on the analysis of School Entry Medical Examination (SEME), the study investigates the possible influence of NHC on children's health.

METHOD

A retrospective epidemiological analysis of the sociodemografic and health-related differences among subgroups nc and n-nc based on SEME, school year 2016/2017 (network children/nc: 1,152, not network children/n-nc: 20,954), using descriptive statistics; a logistic regression analysis assessing, for instance, the power of NHC's influence on health adjusting also for social status and region.

RESULTS

Parents with low/middle social status and one-parent families participated more frequently in the NHC (p<0.001). Nc compared to n-nc brought check-up documents (94.3 / 91.5%, p<0.001) and vaccination certificates (95.7 / 91.7%, p<0.001) more frequently to SEME. A higher tetanus-diphtheria-pertussis booster rate was observed after network participation. The adjusted model showed nc were less likely to have incomplete (U2-U6) check-ups (OR 0.347 [95%-KI: 0.192-0.627, p<0.001]), vaccination gaps (OR 0.621 [95%-KI: 0.508-0.758, p<0.001]) and more likely to be "optimally cared for" (OR 1.355 [95%-KI: 1.175-1.562, p<0.001]).

CONCLUSION

Children's health showed benefit from network participation.

Kognitive Leistungen bei rechenschwachen Grundschulkindern

Zusammenfassung. Es werden die visuellen Wahrnehmungsleistungen und weitere kognitive Leistungen von Grundschulkindern mit Rechenstörungen betrachtet. Hierzu werden die Indexwerte der Wechsler Intelligence Scale for Childen – IV (WISC-IV) und die in Frostigs Entwicklungstest der visuellen Wahrnehmung für Jugendliche und Erwachsene (FEW-JE) erzielten Werte von 39 Kindern mit Rechenstörung und 40 Kontrollgruppenkindern analysiert. Die visuellen Wahrnehmungsleistungen unterscheiden sich signifikant. 39 % der rechenschwachen Kinder weisen klinisch auffällige Ergebnisse im FEW-JE auf. In Abhängigkeit von den diagnostischen Kriterien lässt sich für 3 bis 13 % eine „visuelle Wahrnehmungsstörung“ diagnostizieren. In der Regressionsanalyse erklären die Prädiktoren „visuellen Wahrnehmung“ und „Arbeitsgedächtnis“ 35 bis 53 % der Rechenleistung. Im Rahmen der klinischen Diagnostik von Rechenstörungen ist eine Überprüfung der visuellen Wahrnehmungs- und Arbeitsgedächtnisleistungen anzuraten.