Bergen B Nelson1, Rebecca N Dudovitz2, Tumaini R Coker3, Elizabeth S Barnert2, Christopher Biely2, Ning Li4, Peter G Szilagyi2, Kandyce Larson5, Neal Halfon6, Frederick J Zimmerman7, Paul J Chung8. 1. 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; bnelson@mednet.ucla.edu. 2. 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; 3. 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; RAND Health, RAND Corporation, Santa Monica, California; 4. Department of Biomathematics, University of California, Los Angeles, Los Angeles, California; 5. American Academy of Pediatrics, Elk Grove Village, Illinois, and. 6. 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; 7. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. 8. 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; RAND Health, RAND Corporation, Santa Monica, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
Abstract
BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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