Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; United States of America.
Martha S. Pitzer Center for Women, Children & Youth, The Ohio State University College of Nursing, OH, United States of America.
J Pediatr Nurs. 2020 Sep-Oct;54:86-92. doi: 10.1016/j.pedn.2020.06.010. Epub 2020 Jul 15.
This paper presents an analysis of Head Start (HStart) preschooler data by severity of developmental concern, while considering socio-demographic and other factors that highlight racial and ethnic disparities in the early identification of developmental delay or disability (DD).
We conducted an analysis of 2014-2015 academic year data for preschool-aged children in HStart in both urban and suburban centers in a large Midwestern city. Descriptive statistics were used to determine the prevalence of developmental concerns and compare characteristics of children with mild-to-moderate versus severe developmental concerns; differences between groups were compared using t-tests and chi-square tests. Multivariate logistic regression was used to determine the independent effect of each predictor of concern severity.
Nearly one-third of HStart preschoolers were identified with developmental concern; 70% were mild-to-moderate risk for DD and the remaining severe risk. Neither group was routinely referred to healthcare for evaluation or treatment, and most of the severe risk group did not qualify nor receive treatment for DD with an Individualized Education Plan. Suburban and urban preschoolers with severe concern were less likely to be African American or Latinx, suggesting that racially and ethnically diverse preschoolers in HStart may be under-identified and under-treated.
Lags in the educational diagnosis of DD may mirror the disparities in diagnosis and treatment of DD among minority groups. Primary care is the first line for detection and treatment of DD, and offers a unique opportunity to act for racially and ethnically diverse HStart preschoolers disproportionately at-risk for DD.
本文通过发育问题的严重程度分析了“开端计划”（Head Start）学龄前儿童的数据，同时考虑了社会人口学和其他因素，这些因素突出了在早期识别发育迟缓或残疾（DD）方面的种族和族裔差异。
我们对中西部大城市城乡中心 2014-2015 学年“开端计划”中学龄前儿童的数据进行了分析。使用描述性统计数据来确定发育问题的流行率，并比较轻度至中度与重度发育问题儿童的特征；使用 t 检验和卡方检验比较组间差异。使用多元逻辑回归确定每个关注严重程度预测因子的独立影响。
近三分之一的“开端计划”学龄前儿童被确定存在发育问题；70%有轻度至中度发育迟缓风险，其余为重度风险。两个组都没有常规转介到医疗保健机构进行评估或治疗，并且大多数重度风险组都不符合也没有获得个人教育计划（IEP）的 DD 治疗。有重度关注的城乡学龄前儿童不太可能是非裔美国人和拉丁裔，这表明“开端计划”中种族和族裔多样化的学龄前儿童可能被低估和治疗不足。
DD 教育诊断的滞后可能反映了少数民族群体中 DD 的诊断和治疗差距。初级保健是 DD 检测和治疗的第一线，为检测和治疗不成比例地处于 DD 高风险的种族和族裔多样化的“开端计划”学龄前儿童提供了独特的机会。
