Nelson Bergen B, Dudovitz Rebecca N, Coker Tumaini R, Barnert Elizabeth S, Biely Christopher, Li Ning, Szilagyi Peter G, Larson Kandyce, Halfon Neal, Zimmerman Frederick J, Chung Paul J
Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; UCLA Center for Healthier Children, Families and Communities, Los Angeles, California;
Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California;
Pediatrics. 2016 Aug;138(2). doi: 10.1542/peds.2015-4477. Epub 2016 Jul 18.
Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors.
Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), were used for this study. The analytic sample excluded children likely eligible for EI because of DDs or very low birth weight. Dependent variables included low academic scores and high problem behaviors at the kindergarten wave. Regression models were developed by using candidate predictors feasibly obtainable during typical 2-year well-child visits. Models were cross-validated internally on randomly selected subsamples.
Approximately 24% of all 2-year-old children were ineligible for EI at 2 years of age but still had poor academic or behavioral outcomes at school entry. Prediction models each contain 9 variables, almost entirely parental, social, or economic. Four variables were associated with both academic and behavioral risk: parental education below bachelor's degree, little/no shared reading at home, food insecurity, and fair/poor parental health. Areas under the receiver-operating characteristic curve were 0.76 for academic risk and 0.71 for behavioral risk. Adding the mental scale score from the Bayley Short Form-Research Edition did not improve areas under the receiver-operating characteristic curve for either model.
Among children ineligible for EI services, a small set of clinically available variables at age 2 years predicted academic and behavioral outcomes at school entry.
当前建议强调进行发育筛查与监测,以识别发育迟缓(DD)儿童,以便将其转介至早期干预(EI)服务。然而,许多没有发育迟缓的幼儿在入学时面临发育和行为不良后果的高风险,但不符合早期干预的条件。我们针对没有发育迟缓的2岁儿童开发了模型,用于预测其幼儿园入学时学业成绩不佳和问题行为较多的情况。
本研究使用了儿童早期纵向研究出生队列(ECLS - B)的数据。分析样本排除了因发育迟缓或极低出生体重而可能符合早期干预条件的儿童。因变量包括幼儿园阶段的低学业成绩和高问题行为。通过使用在典型的2岁儿童健康检查期间可实际获得的候选预测因素来建立回归模型。模型在随机选择的子样本上进行内部交叉验证。
所有2岁儿童中约24%在2岁时不符合早期干预条件,但在入学时仍有不良的学业或行为结果。每个预测模型包含9个变量,几乎全部是与父母、社会或经济相关的变量。四个变量与学业和行为风险均相关:父母教育程度低于学士学位、在家很少/没有亲子阅读、粮食不安全以及父母健康状况一般/较差。学术风险模型的受试者工作特征曲线下面积为0.76,行为风险模型的为0.71。在两个模型中加入贝利简短版研究版的心理量表得分均未改善受试者工作特征曲线下面积。
在不符合早期干预服务条件的儿童中,一组在2岁时临床上可获得的变量能够预测其入学时的学业和行为结果。