Does Parents' Evaluation of Developmental Status at School Entry Predict Language, Achievement, and Quality of Life 2 Years Later?

School readiness screening and educational achievement at 9-10 years of age

AIM

To determine whether a multi-domain school readiness screening, the Before School Check (B4SC), identifies children at risk of low educational achievement and to compare the educational outcomes between those referred for intervention and those with B4SC concerns who were not referred.

METHODS

In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia (N 331), the B4SC was performed at 4.5 years of age and a standardised curriculum-based measure of educational achievement was completed at 9-10 years of age. Outcomes of school readiness screening were categorised into 'school readiness concern' or 'no school readiness concern' while 'below standard' and 'well below standard' ratings of educational achievement were combined into a single category of 'low educational achievement'.

RESULTS

Overall, 52% of children had ≥1 school readiness concerns at the B4SC, predominantly about behaviour (46%). Having ≥1 school readiness concern was associated with a nearly twofold increase in the likelihood of low academic achievement (OR 1.85, 95% CI 1.14, 3.02), which was apparent only for behaviour concerns. Of the 128 children with behaviour concerns, only 10 (8%) were referred for further interventions. There was a statistically non-significant increase in the rates of low academic achievement among those referred than those non-referred (60% vs. 47%).

CONCLUSION

Identification of behaviour concerns during B4SC is associated with a moderate increase in the likelihood of low academic achievement at 9-10 years. Further, research is needed to determine how academic achievement can be improved in children with behaviour concerns at school entry.

Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review

Context: Parent/caregiver completing developmental screening questionnaires (DSQs) for children before 5 years of age is currently recommended. The DSQs recommended by the American Academy of Pediatrics (AAP) are the Ages and Stages Questionnaires (ASQ), Parents' Evaluation of Developmental Status (PEDS), and the Survey of Well-being of Young Children (SWYC). Nevertheless, their predictive validity has not been well-established. Objective: To assess in the current literature, the value of AAP-recommended DSQs (ASQ, PEDS, SWYC) administered between 0 and 5 years of age, for predicting long-term cognitive achievement and/or school performance (CA/SP), after 1 year or more of evaluation and at/or after age 5 years, in the general population. Data Sources: Cochrane, MEDLINE PubMed, CINAHL, EMBASE, Web of Science, Scielo, and Scopus databases (until March 2021). Study Selection: Two authors selected the studies. Forward and backward citation follow-up was done; authors of DSQ were contacted to identify additional studies. Data Extraction: Cohorts were identified, and authors of selected studies were contacted to corroborate and complete extracted data. Results: Thirty-two publications, corresponding to 10 cohorts, were included. All cohorts used ASQ. Only cohort using PEDS was identified but did not meet the inclusion criteria. No cohorts conducted with SWYC were identified. Associations between ASQ and CA/SP were extracted for eight cohorts. The odds ratios were >3, and the area under the curve was 0.66-0.87. A trade-off between sensitivity and specificity was observed. Limitations: Heterogeneity in population characteristics and in DSQ adaptations. Conclusions: A positive association between ASQ and later CA/SP was found in different social, cultural, and economic settings. Additional studies are necessary to determine the impact factors in the predictive capacity of DSQs. Systematic Review Registration: PROSPERO, identifier: CRD42020183883.

The Efficacy of Preschool Developmental Indicators as a Screen for Early Primary School-Based Literacy Interventions

Literacy success lays the foundation for children's later educational, health, and well-being outcomes. Thus, early identification of literacy need is vital. Using data from New Zealand's national preschool health screening program for fiscal years 2010/2011-2014/2015, demographic and health variables from 255,090 children aged 4 years were related to whether they received a literacy intervention in early primary school. Overall, 20,652 (8.1%) children received an intervention. Time-to-event analysis revealed that all considered variables were significantly related to literacy intervention (all p < .01), but the full model lacked reasonable predictive power for population screening purposes (Harrell's c-statistic = .624; 95% CI [.618, .629]). Including more direct literacy measures in the national screening program is likely needed for improvement.

Patterns of early primary school-based literacy interventions among Pacific children from a nationwide health screening programme of 4 year olds

Literacy success is critical to unlocking a child's potential and enhancing their future wellbeing. Thus, the early identification and redressing of literacy needs is vital. Pacific children have, on average, the lowest literacy achievement levels in New Zealand. However, this population is very diverse. This study sought to determine whether the current national health screening programme of pre-school children could be used as an early detection tool of Pacific children with the greatest literacy needs. Time-to-event analyses of literacy intervention data for Pacific children born in years 2005-2011 were employed. A multivariable Cox proportional hazard model was fitted, and predictive assessment made using training and test datasets. Overall, 59,760 Pacific children were included, with 6,861 (11.5%) receiving at least one literacy intervention. Tongan (hazard ratio [HR]: 1.33; 95% confidence interval [CI]: 1.23, 1.45) and Cook Island Māori (HR: 1.33; 95% CI: 1.21, 1.47) children were more likely to receive an intervention than Samoan children; whereas those children with both Pacific and non-Pacific ethnic identifications were less likely. However, the multivariable model lacked reasonable predictive power (Harrell's c-statistic: 0.592; 95% CI: 0.583, 0.602). Regardless, important Pacific sub-populations emerged who would benefit from targeted literacy intervention or policy implementation.

Preschool children's communication, motor and social development: Parents' and educators' concerns

PURPOSE

During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents' and educators' concerns, (2) examine inter-rater reliability between parents' and educators' concerns and (3) determine the group difference between level of concern and children's performance on clinical testing.

METHOD

Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents' Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n = 275), receptive vocabulary (n = 131) and language (n = 274).

RESULT

More parents/educators were concerned about children's speech and expressive language, than behaviour, social-emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents' and educators' responses were significantly correlated (except gross motor). Parents' and educators' level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators' level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

CONCLUSION

Children's communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.

Pre-school screening for developmental and emotional health: Comparison with neurodevelopmental assessment

AIM

The study aim was to compare detection of and referral for developmental and emotional problems in a school readiness screening programme (New Zealand Before School Check, B4SC) with that of a comprehensive neurodevelopmental assessment.

METHODS

This is a prospective cohort study of children (n = 274) born at risk of neonatal hypoglycaemia and recruited to a follow-up study of neurodevelopmental outcomes at 4.5 years (Children with Hypoglycaemia and their Later Development (CHYLD) Study). Children identified as of significant concern for developmental and emotional problems, and referrals made, were compared in the B4SC and CHYLD Study. Scores of the parent-completed Strengths and Difficulties Questionnaire used in both assessments were compared.

RESULTS

Of the 274 children who underwent clinical neurodevelopmental assessment at a mean (standard deviation) age of 53.3 (1.8) months, 237 had the B4SC developmental and emotional health screening. Of these, 44 (19%) children met B4SC referral criteria, and 15 (6%) were referred, but only 21 (9%) children met CHYLD referral criteria, and 10 (4%) were referred. Twelve children (5%) met both the B4SC and CHYLD referral criteria, and two were referred by both. When assessed twice, 39 (17%) children changed parent-completed Strengths and Difficulties Questionnaire category. Children who did not have B4SC screening had higher mean total difficulties score (10.5 vs. 8.2, P = 0.009) and were more likely to have cognitive delay than those who were screened (19% vs. 8%, P = 0.04).

CONCLUSION

More children met referral criteria for the B4SC screening programme than for a more comprehensive neurodevelopmental assessment. Children who did not have screening had a higher incidence of cognitive and behaviour problems than those who did.

The population cost-effectiveness of a parenting intervention designed to prevent anxiety disorders in children

BACKGROUND

Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population.

METHOD

A cost-utility economic framework, using Disability-Adjusted-Life-Years (DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio (ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis.

RESULTS

The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing.

CONCLUSIONS

Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken.

What patterns of postpartum psychological distress are associated with maternal concerns about their children's emotional and behavioural problems at the age of three years?

Mothers experiencing psychological distress in the postpartum period may have difficulties parenting their children. Inconsistent and unresponsive parenting may increase the risk of later emotional and behavioural problems in children. The purpose of this study was to identify how maternal psychological characteristics cluster at eight weeks postpartum, and whether these clusters were associated with maternal-reported child emotional and behavioural problems at the age of three years, as measured by the Parents' Evaluation of Developmental Status (PEDS) questionnaire. In a longitudinal pregnancy cohort (N = 647), three clusters of postpartum psychological characteristics were identified. Contrary to expectations, mothers with the greatest psychological distress did not report concerns about their child's emotional and behavioural problems; rather, they reported concerns about global developmental delay. These findings suggest that infants of mothers experiencing postpartum psychological distress should receive additional follow-up to reduce the risk for global developmental delay.

A systematic review of the prevalence of parental concerns measured by the Parents' Evaluation of Developmental Status (PEDS) indicating developmental risk

BACKGROUND

Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors.

METHODS

Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk.

RESULTS

Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk.

CONCLUSIONS

The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity.

TRIAL REGISTRATION

PROSPERO Registration: CRD42012003215.

Emotion Knowledge and Self-Regulation as Predictors of Preschoolers’ Cognitive Ability, Classroom Behavior, and Social Competence

The development of children’s cognitive and social skills is a topic of considerable importance and interest in education and educational psychology. The current study examines whether emotion knowledge and self-regulation predict cognitive competence, social competence, and classroom behavior problems among a sample of 74 preschoolers (40 boys). A hierarchical regression was used to control for age, child gender, and family income level before predicting cognitive competence, social competence, and classroom behavior problems from emotion knowledge and self-regulation. Emotion knowledge incrementally predicted both cognitive competence (Δ R2 = .06) and social competence (Δ R2 = .08) but not classroom behavior problems. Conversely, self-regulation predicted classroom behavior problems (Δ R2 = .07) but not cognitive or social competence. In addition, results demonstrated that the situation knowledge (not the expression knowledge) component of emotion knowledge was the active ingredient for both cognitive and social competence. However, different aspects of self-regulation were relevant for different outcomes: The attentional control element was important for cognitive competence, whereas the positive emotionality element was important for social competence and behavior problems. The study demonstrates that emotion-related competencies are important prerequisites for valued educational and social outcomes in preschoolers.

Can preschool developmental screening identify children at risk for school problems?

Screening preschool children for potential school problems may allow early intervention. Children beginning first grade (N=980) were tested with Denver II. All with normal/questionable results had satisfactory school performance while 26% of those with abnormal Denver II had low school scores. 43%, 27% and 0% of children with abnormal, questionable, and normal Denver II respectively had IQ<90 on WISC-R (p=0.05). Preschool Denver II can be recommended for populations at risk.