Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Institute for Pedagogy, Sensory and Media Ecology, Stuttgart, Germany.
BMJ Open. 2018 Oct 10;8(10):e020820. doi: 10.1136/bmjopen-2017-020820.
Young age at school entry (ASE) for students has been related to their impaired mental health in higher grades. To avoid the negative health consequences of young ASE, preschool examinations and individual school entry deferral for young children are routinely performed by some school authorities. We aimed to investigate whether ASE was associated with attention-deficit hyperactivity disorder (ADHD)-related symptoms in pupils attending schools using a selective school enrolment procedure.
Prospective open cohort study with baseline assessments at school entry and two follow-ups in the second and fourth grades.
Up to 128 Rudolf Steiner Schools (Waldorf Schools) located within Germany.
Of the 3079 children from whom data were gathered in the second or fourth grade, 2671 children born between 1 July 2001 and 31 October 2002 (age at baseline: mean 6.7, min 5.91, max 7.24 years, 50% girls) were selected for analysis to avoid bias introduced by individuals at the edges of the ASE distribution.
ADHD-related symptoms were assessed at school entry and second and fourth grades by parent-reported and teacher-reported versions of the Strengths and Difficulties Questionnaire (Hyperactivity-Inattention Subscale).
The agreement between parent-reported and teacher-reported symptoms was poor (intra-class correlation: 0.41 and 0.44 in second and fourth grade assessments, respectively). Regarding teacher reports, ASE was negatively associated with ADHD-related symptoms in the second grade (regression coefficient β=-0.66 per year, P=0.0006) and fourth grade (β=-0.56, P=0.0014). Associations remained after adjusting for potential confounders and pre-existing symptoms at baseline. Regarding parent reports, associations were markedly weaker in both grades (second grade: β=-0.22, P=0.12; fourth grade: β=-0.09, P=0.48).
Using a prospective study design and comprehensive adjustment for confounding and baseline symptoms, we confirmed prior evidence of the association between young ASE and teacher-reported ADHD symptoms in primary school.
入学年龄较小（ASE）与学生较高年级的心理健康受损有关。为了避免 ASE 年龄较小带来的负面健康后果，一些学校当局通常会对学前儿童进行学前考试和个别入学延迟。我们旨在研究通过选择性入学程序入读学校的小学生的 ASE 是否与注意力缺陷多动障碍（ADHD）相关症状有关。
入学时进行基线评估，并在第二和第四年级进行两次随访的前瞻性开放队列研究。
德国境内多达 128 所鲁道夫·施泰纳学校（华德福学校）。
在第二或第四年级收集数据的 3079 名儿童中，选择了 2671 名于 2001 年 7 月 1 日至 10 月 31 日之间出生的儿童（入学时的年龄：平均值 6.7 岁，最小 5.91 岁，最大 7.24 岁，50%为女孩）进行分析，以避免由 ASE 分布边缘的个体引入的偏差。
入学时以及第二和第四年级通过父母报告和教师报告的《长处与困难问卷》（多动-注意力不集中分量表）评估 ADHD 相关症状。
父母报告和教师报告的症状之间的一致性较差（第二年级和第四年级评估的内部一致性系数分别为 0.41 和 0.44）。关于教师报告，ASE 与第二年级（回归系数β=-0.66 岁/年，P=0.0006）和第四年级（β=-0.56，P=0.0014）的 ADHD 相关症状呈负相关。在调整潜在混杂因素和基线时的现有症状后，关联仍然存在。关于父母报告，两个年级的关联明显较弱（二年级：β=-0.22，P=0.12；四年级：β=-0.09，P=0.48）。
使用前瞻性研究设计和综合调整混杂因素和基线症状，我们证实了之前关于 ASE 年龄较小与小学教师报告的 ADHD 症状之间关联的证据。
