We are all aware of the importance of developmental surveillance on identifying signs of delay in cognitive, language, social, or motor skills during infancy and toddlerhood—and despite our best efforts in surveillance at every health maintenance visit, we all have patients who appear developmentally on track and yet start kindergarten and have a difficult time in terms of their behavior or academic performance.
Are there other signs or symptoms of poor school readiness in the absence of finding delay using the tools we currently have? Nelson et al. (peds.2015-4477) set out to determine just that by trying to develop models for children with no detected delay at age 2, and yet difficulty getting going in kindergarten at age 5. The authors used data from a longitudinal birth cohort and excluded children eligible for early intervention because of risk factors like identified delay or having been classified as very low birth weight and looked at their academic testing scores and for problem behaviors upon starting kindergarten.
They looked back at the 2 year visit to see if there were factors that could signal poor school performance beyond developmental screening tools. The answer is a hopeful yes in that the authors noted almost a quarter of the children studied met criteria for poor school readiness and this group were associated with 9 variables that could be built into a prediction model that might better help us identify earlier that these children are at risk. The variables all focus around parental, social and/or economic issues, and four of the nine were associated with both academic and behavioral risk.
Just what these four are, we’ll save for you to read about in the study—and while you are doing that, please don’t miss the accompanying commentary by developmental and behavioral experts Drs. Voigt and Accardo (peds.2016-0432) who further comment on the import of this study and how it can influence our ability to identify at risk, non-delayed toddlers long before they start school so that supportive services might be instituted to give these children a better start. To find out what the variables are and why they are so important to identify during routine office visits, read both articles and then see whether the findings might help you identify learning issues sooner than later.
