Emerson E, Brigham P
Centre for Disability Research and Policy, University of Sydney, Sydney, NSW, Australia.
Child Care Health Dev. 2015 Mar;41(2):249-57. doi: 10.1111/cch.12144. Epub 2014 May 6.
Research on child development in general has highlighted the importance that the family environment plays in mediating the pathway between exposure to low socio-economic position (SEP) and child well-being. While child developmental models in intellectual disability have highlighted the interplay between social context, family environment and child development, little empirical work has attempted to formally evaluate the evidence in support of specific mediating pathways between low SEP and child outcomes.
Secondary analysis of cross-sectional confidentialized needs analysis data collected in three Primary Care Trusts in England covering a total population of 1.25 million people. Case record reviews were undertaken for 46 023 households, 2236 (4.9%) of which contained a child in the target age range with developmental delay.
Children with developmental delay, when compared with their non-disabled peers, were at significantly increased risk of poorer health outcomes and of being exposed to a wide range of social determinants of poor health. Controlling for between-group differences in exposure to social determinants of poor health reduced the risk of developmental delay being associated with poorer health outcomes by 45% for behaviour problems and 89% for risk of significant harm. For children with developmental delay, parenting difficulties appears to play a particularly significant role in partially mediating the effects of low SEP.
The findings of the present study point to the potential effectiveness of family-focused early intervention to prevent the emergence and escalation of behavioural difficulties and health problems in children with developmental delay.
总体而言，关于儿童发育的研究突出了家庭环境在调节低社会经济地位（SEP）暴露与儿童福祉之间路径方面所起的重要作用。虽然智力残疾儿童发育模型强调了社会环境、家庭环境与儿童发育之间的相互作用，但很少有实证研究试图正式评估支持低SEP与儿童结局之间特定中介路径的证据。
对英格兰三个初级保健信托基金收集的横断面保密需求分析数据进行二次分析，覆盖总人口125万。对46023户家庭进行了病例记录审查，其中2236户（4.9%）有一名处于目标年龄范围且发育迟缓的儿童。
与非残疾同龄人相比，发育迟缓儿童健康状况较差以及接触多种不良健康社会决定因素的风险显著增加。控制组间在接触不良健康社会决定因素方面的差异后，发育迟缓与较差健康结局相关的风险在行为问题方面降低了45%，在重大伤害风险方面降低了89%。对于发育迟缓儿童，育儿困难似乎在部分介导低SEP的影响方面发挥了特别重要的作用。
本研究结果表明，以家庭为重点的早期干预对于预防发育迟缓儿童行为困难和健康问题的出现及升级具有潜在效果。
