Predicting Child Outcomes at the End of Kindergarten from the Quality of Pre-Kindergarten Teacher–Child Interactions and Instruction

Publicly funded prekindergartens are programs that most states use to promote school readiness, especially of 4-year-old children at risk for academic problems due to poverty. Despite large public expenditures, these programs have not been widely evaluated. We examined 240 randomly selected pre-kindergarten programs in six states with mature programs that serve large numbers of children, and evaluated specific aspects of classroom quality and children's academic achievement in both the pre-kindergarten and kindergarten year for over 700 children. Results showed that, on average, pre-kindergarten teachers were moderately responsive and sensitive, but were less successful in engaging children in learning specific skills. Both sensitive and stimulating interactions with the teacher and the instructional quality aspects of the pre-kindergarten classroom predicted the acquisition of language, pre-academic, and social skills through the end of the kindergarten year.     

How good is general practice developmental screening?

All developmental screening in Somerset is performed by general practitioners and health visitors. A retrospective review of a cohort of 1504 7 year old children living in semirural Somerset found that the development assessment by a health visitor at age 3 1/2 years had a sensitivity of 45% for identifying the 103 children with special educational needs, whereas the sensitivity of the preschool examination by a general practitioner was 56%. There was no relation between results of preschool developmental assessment and later reading ability. Of the 23 children in special schools, 22 had been identified independently of the developmental screening programme before starting school. Intervention was started at a mean age of 1 year 5 months (range 2 months to 3 years) for children with severe learning difficulties, and 3 years 9 months (2 years 3 months to 6 years 6 months) for children with moderate learning difficulties. The preschool medical examination revealed fairly minor medical problems: 29 of 81 children referred for specialist opinions were shown to be medically normal, and for only seven of the medically abnormal children was information about their conditions given to their teachers. In Somerset screening the development of all children at predetermined ages has not been very useful.     

Preschool detection of asymptomatic bacteriuria: a public health program.

A total of 95% of parents registering their children for kindergarten agreed to screening for urinary tract infection (UTI) in their children. Urine specimens from 1591 children (87%), obtained at the school or at home, were tested. Only minor problems were encountered when parents prepared the specimens at home and mailed them to the laboratory for reading; the proportion of false-positive results was higher in these samples. If screening for UTI becomes established, it appears worth while to conduct this at the time of registration for kindergarten, either in the school by lay persons or in the home by parents.     

Screening for hearing loss in childhood: a study of national practice.

A questionnaire survey of all health districts in England and Wales was carried out at the end of 1984 to document screening programmes for identifying hearing loss in childhood. The response rate was 81.3%. All districts performed distraction testing, all but nine aiming at doing so at 7-9 months of age. All districts tested children''s hearing at school, generally before 7 years of age. The number of times that children were screened both before school and at school varied considerably, from one to six times before school and one to six times at school. Few districts collected information that would allow them to make judgments about the efficiency of effectiveness of their screening programmes.     

Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study.

OBJECTIVE--To determine whether an intervention programme based on existing school and community resources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma. DESIGN--Parallel group controlled intervention study. SETTING--102 primary schools in Nottingham: 49 were randomised to receive the intervention and 53 to be control schools. SUBJECTS--All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only. INTERVENTIONS--Children with asthma were referred to their general practitioner for assessment of symptoms and treatment. Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools. MAIN OUTCOME MEASURES--Changes in school absence and missed games and swimming lessons because of wheezing, and schools'' policy towards management of asthma in school. RESULTS--Of 17,432 children screened, 451 met the entry criteria--228 in intervention schools and 223 in control schools. 152 (67%) children in intervention schools visited their general practitioner, of whom 39 (26%) were given a new diagnosis of asthma and 58 (38%) had treatment for asthma increased or changed. Over the next academic year mean (SE) parent reported school absence due to wheezing fell significantly, but to a similar extent, in both intervention and control schools (0.82 (0.11) and 1.09 (0.21) weeks respectively). There was little change in school recorded absence or participation in games lessons and swimming lessons in either group. At the end of the study intervention schools were more likely to have improved aspects of management of asthma in school. CONCLUSION--The intervention resulted in a majority of children being assessed by their general practitioner and improved teachers'' understanding and management of asthma, but it did not result in any appreciable reduction in morbidity.     

A trial speech screening test for school entrants.

An objective, low-cost means of screening school entrant children for speech disorders was designed, and speech therapists evaluated the doctor''s screening results. In a field trial comprising 438 children, an accuracy rate of 92% was reported, with a referral rate by doctors of 14%, and speech therapists subsequently observing or treating 10%. The trial showed also the effects on accuracy rates of setting different pass levels.     

Variation of behavioral and physiological variables in children attending kindergarten and primary school

Twenty-one children aged 5-6 years (mean age: 71.2 months; S.D. = 2.7) were videotaped in 4 different kindergartens throughout the school day for a period of one week. Eighteen of these children were then followed up after the summer holidays and videotaped for one week while attending the first year of primary school. The behaviors measured for each child were yawning and general motor activity. It was found that: (1) The frequency of yawning appears to be 5 times higher in the first year of primary school than in the last year of kindergarten; (2) Throughout the school-day the percentage of yawning children is higher in the first year of primary school, with the exception of the 1400-1430 period; (3) In the first year of primary school, the percentage of yawning children and the frequency of yawning peak between 900 and 930 and 1430 and 1500; (4) In this school institution the percentage of children who get up from their chair and spontaneously move above increases from the beginning to the end of each school-day. Three cardio-vascular variables were investigated in 17 children of the sample population: heart rate, systolic and diastolic blood pressure. We found that: (1) The lowest values for heart rate in the first year of primary school are in agreement with the classical data of child development, as the children are 5-6 months older than in the last year of kindergarten. However, this is not the case at 1400 when the heart rate peaks at a higher level in the first year of primary school; (2) If the evolution in time of the blood pressure agrees in both institutions with the classical data of human chronobiology, i.e. the maximum values at 1400, the differences in mean level at all times during the school day between both institutions do not agree with what is commonly accepted, i.e. an increase in blood pressure with age; (3) The amplitude of the variations of the heart rate and blood pressure from one 30-min period to another throughout the school day is significantly higher in primary school. The comparison of the data obtained in both school institutions suggests that the observed differences are related to sharp modifications in school rhythms and constraints when the children go from the last year of kindergarten to the first year of primary school.     

Introduction

Twenty-one children aged 5-6 years (mean age: 71.2 months; S.D. = 2.7) were videotaped in 4 different kindergartens throughout the school day for a period of one week. Eighteen of these children were then followed up after the summer holidays and videotaped for one week while attending the first year of primary school. The behaviors measured for each child were yawning and general motor activity.

It was found that: (1) The frequency of yawning appears to be 5 times higher in the first year of primary school than in the last year of kindergarten; (2) Throughout the school-day the percentage of yawning children is higher in the first year of primary school, with the exception of the 1400-1430 period; (3) In the first year of primary school, the percentage of yawning children and the frequency of yawning peak between 900 and 930 and 1430 and 1500; (4) In this school institution the percentage of children who get up from their chair and spontaneously move above increases from the beginning to the end of each school-day.

Three cardio-vascular variables were investigated in 17 children of the sample population: heart rate, systolic and diastolic blood pressure.

We found that: (1) The lowest values for heart rate in the first year of primary school are in agreement with the classical data of child development, as the children are 5-6 months older than in the last year of kindergarten. However, this is not the case at 1400 when the heart rate peaks at a higher level in the first year of primary school; (2) If the evolution in time of the blood pressure agrees in both institutions with the classical data of human chronobiology, i.e. the maximum values at 1400, the differences in mean level at all times during the school day between both institutions do not agree with what is commonly accepted, i.e. an increase in blood pressure with age; (3) The amplitude of the variations of the heart rate and blood pressure from one 30-min period to another throughout the school day is significantly higher in primary school.

The comparison of the data obtained in both school institutions suggests that the observed differences are related to sharp modifications in school rhythms and constraints when the children go from the last year of kindergarten to the first year of primary school.     

Physician communication skills and malpractice claims. A complex relationship.

We assessed the relationship between patients'' opinions about their physicians'' communication skills and the physician''s history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient''s individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims.     

Use of botulinum toxin

In an extensive survey of postgraduate physicians in two teaching hospitals (N = 141) for their humanistic attitudes, values and behavior, all ratings of physicians'' humanistic performance, including physicians'' own scores on self-report measures, supervising faculty, nurses and patient ratings, were modestly but significantly correlated with each other. Sex, ethnic or racial background, year of training, marital status, number of children, Alpha-Omega-Alpha membership or number of articles published were unrelated to physicians'' humanistic behavior. Several measures of humanism were positively correlated with having taken more courses in the social sciences and humanities, having had more early person-centered work experience and reporting that before medical school others had confided in them or sought their advice more frequently.     

Population-Level Associations between Preschool Vulnerability and Grade-Four Basic Skills

Background

This is a predictive validity study examining the extent to which developmental vulnerability at kindergarten entry (as measured by the Early Development Instrument, EDI) is associated with children''s basic skills in 4th grade (as measured by the Foundation Skills Assessment, FSA).

Methodology/Principal Findings

Relative risk analysis was performed on a large database linking individual-level EDI ratings to the scores the same children obtained on a provincial assessment of academic skills (FSA – Foundation Skills Assessment) four years later. We found that early vulnerability in kindergarten is associated with the basic skills that underlie populations of children''s academic achievement in reading, writing and math, indicating that the Early Development Instrument permits to predict achievement-related skills four years in advance.

Conclusions/Significance

The EDI can be used to predict children''s educational trends at the population level and can help select early prevention and intervention programs targeting pre-school populations at minimum cost.     

我国学校微生物污染状况研究进展与展望

学校环境卫生状况与师生健康密切相关。本文从饮食卫生、公共场所卫生、个人卫生等几个方面对目前我国学校微生物污染状况的研究进展进行了综述,并对未来的研究前景进行了展望,以期为相关部门和个人提供较为全面的学校卫生信息,为学校卫生治理和疾病防控提供参考。     

Bacterial aerosols in an urban nursery school in Gliwice,Poland: a case study

This work presents the results of the study of airborne bacteria in a kindergarten in Gliwice, Upper Silesia, Poland. In this study, the samples of bioaerosols were collected using six-stage Andersen cascade impactor (with aerodynamic cutoff diameters 7.0, 4.7, 3.3, 2.1, 1.1, and 0.65 μm). The level of culturable bacterial aerosols indoors was about 3000 CFU m^?3—six to eight times higher than outdoors. In the classrooms, respirable bacterial particles, <4.7 µm, contributed up to 85 % of the total number of culturable bacteria, increasing the possible adverse health effects due to their inhalation. The identification of the bacterial species showing the dominance of gram-positive cocci in the indoor environment and non-sporing gram-positive rods in the outdoor air indicates that most of the bacteria present in the studied kindergarten are human origin. Using the obtained data, the nursery school exposure dose (NSED) of bioaerosols was estimated for the children and personnel of this kindergarten (nursery school). The highest value of NSED was obtained for younger children (930 CFU kg^?1) compared to older children (about 600 CFU kg^?1) and to the kindergarten staff (about 300 CFU kg^?1). This result suggests the elevated risk of adverse health effects in younger children exposed to the bioaerosols in the kindergarten, including infections.     

Preventive health care of Indian preschoolers in the Sioux Lookout Zone,northwestern Ontario.

The provision of preventive health care to native children in the Sioux Lookout Zone of northwestern Ontario was assessed by reviewing the medical charts of 568 randomly selected preschoolers in 1980. Data were collected on the method of infant feeding; immunization status, vaccination and testing for tuberculosis; development, vision and hearing screening; monitoring of growth; and nutritional status and vitamin supplementation. Most of the children had been breast-fed and had received primary diphtheria-pertussis-tetanus-polio immunization as well as measles-mumps-rubella and bacille Calmette-Guérin vaccination. However, less than 30% had undergone developmental screening, and only 10% and 8% respectively had had their vision and hearing screened. Growth monitoring was adequate in the first year of life but not thereafter. Only about 55% of the children had ever had a hemoglobin level determined. More emphasis on health promotion is needed if native children are to receive adequate preventive health care.     

A followup study of the academic attainment and classroom behavior of children with elevated dentine lead levels

To investigate the impact of low-level lead exposure on children's behavior within a natural setting, we assessed the school performance of a sample of 141 elementary school children classified according to dentine lead level. Twenty-two children had “elevated” levels (≥20 parts per million), 71 had “midrange” levels (10.0–19.9 parts per million), and 48 had “low” levels (<10 parts per million). Four types of outcome data were collected: (1) scores on a standardized group intelligence test, (2) teachers' ratings, (3) incidence of academic failure (assignment to remedial aid, grade retention), and (4) observations of classroom behavior. In general, higher dentine lead levels were associated with less favorable school performance, with most covariance-adjustedp-values in the range of 0.05–0.15. The incidence of grade retention was the outcome most strongly related to lead level. The pattern of results suggests a consistent, though weak relationship between children's dentine lead levels and elementary school performance.     

Surveillance de la santé à l'école maternelle.

In contrast to the traditional program of health assessment of schoolchildren based on periodic physical examination, the program described in this paper is based on the integration of information and data obtained by observation through the school year from parents, teachers and the school nurse, who coordinates the program. The numbers and the types of problems and the date on which they were identified are compared in an experimental group of 557 kindergarten children and a matched control group of 498 children in whom the traditional program was maintained. For problems of hearing, enuresis, learning and behaviour the number of cases detected was significantly greater in the experimental group than in the control group. Each element of the proposed program is analysed and the advantages of an integrated approach to health assessment of schoolchildren are underlined.     

Evaluation of a structured test and a parent led method for screening for speech and language problems: prospective population based study

ObjectiveTo evaluate two methods for identifying speech and language problems in preschool children.DesignProspective population based study.SettingInner London.ResultsReference assessments and usable scores were obtained for 458 (97%) of the 474 children screened. 98 (21%) children had severe language problems and 131 (29%) needed therapy. The sensitivity and specificity for the structured screening test were 66% (95% confidence interval 53% to 76%) and 89% (85% to 93%) respectively for severe language problems and 54% (43% to 65%) and 90% (85% to 93%) for those needing therapy. The sensitivity and specificity for referral by the parent led method were 56% (40% to 71%) and 85% (78% to 90%) for severe language problems and 58% (44% to 71%) and 90% (83% to 94%) for those needing speech and language therapy.ConclusionsBoth approaches failed to detect a substantial proportion of children with severe language problems and led to over-referral for diagnostic assessments. Screening is likely to be an ineffective approach to the management of speech and language problems in preschool children in this population.

What is already known on this topic

Moderate to severe language difficulties in young children are predictive of long term problems affecting learning, school achievement, and behaviourFormal screening tests are widely used, but relying on parents'' observations and health professionals'' clinical judgment may be more effective in identifying children needing therapy

What this study adds

A commonly used screening test and an approach based on parents'' observations and health visitors'' judgment fail to identify a substantial proportion of children with serious language problems and lead to the over-referral of children without serious difficulties     

Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders

ObjectiveTo test the hypothesis that a community based intervention by secondary child and adolescent mental health services would be significantly more effective and less costly than a hospital based intervention.DesignOpen study with two randomised parallel groups.SettingTwo health districts in the north of England.ParticipantsParents of 3 to 10 year old children with behavioural disorder who had been referred to child and adolescent mental health services.InterventionParental education groups.Results141 subjects were randomised to community (n=72) or hospital (n=69) treatment. Primary outcome data were obtained on 115 (82%) cases a year later. Intention to treat analyses showed no significant differences between the community and hospital based groups on any of the outcome measures, or on costs. Parental depression was common and predicted the child''s outcome.ConclusionsLocation of child mental health services may be less important than the range of services that they provide, which should include effective treatment for parents'' mental health problems.     

The pathogenesis of autism: insights from congenital blindness

There is substantial heterogeneity in the aetiology and clinical presentation of autism. So how do we account for homogeneity in the syndrome? The answer to this question will be critical for any attempt to trace the links between brain pathology and the psychological disabilities that characterize autism. One possibility is that the source of homogeneity in autism is not to be found ''in the child'', but rather in dysfunction of the system constituted by child-in-relation-to-other. We have been exploring this hypothesis through the study of congenitally blind children, among whom features of autism, and the syndrome of autism itself, are strikingly common. To justify such an approach, one needs to establish that the clinical features in blind children have qualities that are indeed ''autistic-like''. We conducted systematic observations of the social interactions of two matched groups of congenitally blind children who do not have autism, rating their social engagement, emotional tone, play and language during three sessions of free play in the school playground. The qualities of social impairment in the more disabled children were similar to those in sighted children with autism. Additional evidence came from independent ratings of the children in a different play setting: on the childhood autism rating scale (CARS), the socially impaired children had ''autistic-like'' abnormalities in both social and non-social domains. If we can determine the way in which congenital blindness predisposes to features of autism, we shall be in a better position to trace the developmental pathways that lead to the syndrome in sighted children.     

Cognitive function and behavioural status in paediatric heart and heart-lung transplant recipients: the Harefield experience.

OBJECTIVE--To assess the psychological impact of cardiac and cardiopulmonary transplantation on children. DESIGN--Retrospective cross sectional study. SETTING--One British centre performing paediatric heart and heart-lung transplant operations, four cardiac units in London, three London schools, two London health centres, and the dental department of a London children''s hospital. SUBJECTS--65 children who had been given heart or heart-lung transplants and two reference groups of 52 children who had had other types of cardiac surgery and 45 healthy children. MAIN OUTCOME MEASURES--Development, cognition, and behaviour at home and at school as assessed by measures with proved validity and reliability. RESULTS--Developmental and cognitive measures indicated that children given transplants had significantly lower scores on several parameters, particularly in terms of development in children under 4 1/2 years of age. Performance on all tests, however, was within the normal range. There were no significant differences in behavioural ratings between the transplant and reference groups, though problem behaviour at home was more prevalent in the transplant group. CONCLUSIONS--Though cognitive development may be within the normal range, there are adverse psychological effects associated with cardiac and cardiopulmonary transplantation. These data indicate the need for a controlled prospective study in which children and their families are seen before and at regular intervals after transplantation. Interventions should be developed that are tailored to the particular needs of this very specialised group of paediatric patients and their families.