A meta-analysis of the validity of the Head-Toes-Knees-Shoulders task in predicting young children's academic performance.

The present study represents the first meta-analytic synthesis of the utility of a widely used early-childhood self-regulation measure, the Head-Toes-Knees-Shoulders task, in predicting children's academic achievement. A systematic review of the literature yielded 69 studies accessed from peer reviewed journals representing 413 effect sizes and 19,917 children meeting the complete set of inclusion and exclusion criteria. Robust variance analysis demonstrated that the Head-Toes-Knees-Shoulders task was a consistent predictor of children's academic achievement across literacy, oral language, and mathematical outcomes. A moderator analysis indicated that in accordance with prior research, the Head-Toes-Knees-Shoulders task was more strongly associated with children's mathematics performance relative to their performance on language and literacy measures. The results of this meta-analysis suggest that the Head-Toes-Knees-Shoulders task demonstrated statistically significant, positive associations with children's overall academic performance. These associations remained stable across different participant and measurement factors and are comparable to meta-analyses examining the self-regulation and academic association with multiple measures of self-regulation and executive function.

Egg Introduction during Infancy is Associated with Lower Fat Mass Index in Females at Early Adolescence.

BACKGROUND: Egg consumption may play an important role in early-life growth given their high-quality protein, essential fatty acids, and micronutrients. OBJECTIVES: Study objectives were to examine the longitudinal associations of infant age at egg introduction with obesity outcomes in early childhood, middle childhood (mid-childhood), and early adolescence. METHODS: We used existing data from 1089 mother-child dyads from Project Viva to estimate age at egg introduction through a questionnaire completed by mothers at ∼1 y postpartum (mean ± SD, 13.3 ± 1.2 mo). Outcome measures included height and weight (early childhood, mid-childhood, and early adolescence), body composition including total fat mass, trunk fat mass, and lean mass (mid-childhood and early adolescence), and plasma adiponectin and leptin (early and mid-childhood and early adolescence). We defined childhood obesity as sex- and age-specific BMI ≥ 95th percentile. We estimated the associations of infant age at egg introduction with risk of obesity using multivariable logistic regression and multivariable linear regression models for BMI-z-score, body composition measures, and adiposity hormones; adjusted for maternal prepregnancy BMI and sociodemographics. RESULTS: Among females, those introduced to egg by the 1-y survey had a lower total fat mass index (confounder-adjusted mean difference, -1.23 kg/m2; 95% CI: -2.14, -0.31), and trunk fat mass index (confounder-adjusted mean difference, -0.57 kg/m2; 95% CI: -1.01, -0.12) in early adolescence compared to those not introduced (reference group). However, no associations between infant age at egg introduction and risk of obesity were observed among males (confounder-adjusted odd ratio [aOR], 1.97; 95% CI: 0.90, 4.30) or females (aOR, 0.68; 95% CI: 0.38, 1.24) across all ages. Egg introduction in infancy was associated with lower plasma adiponectin among females (confounder-adjusted mean difference, -1.93 µg/mL; 95% CI: -3.70, -0.16) in early childhood only. CONCLUSIONS: Egg introduction during infancy among females is associated with lower total fat mass index in early adolescence and plasma adiponectin in early childhood. This trial was registered at clinicaltrials.gov as NCT02820402.

Frequency of Infant Egg Consumption and Risk of Maternal-Reported Egg Allergy at 6 Years.

BACKGROUND: Recent research suggests that early egg introduction during infancy may help to prevent egg allergy development. However, the infant egg consumption frequency that is sufficient to induce this immune tolerance remains uncertain. OBJECTIVES: We examined the associations between the infant egg consumption frequency and maternal-reported child egg allergy at 6 y. METHODS: We analyzed data of 1252 children from the Infant Feeding Practices Study II (2005-2012). Mothers reported the frequency of infant egg consumption at 2, 3, 4, 5, 6, 7, 9, 10, and 12 mo old. Mothers reported the status of their child's egg allergy at the 6-y follow-up. We used Fisher exact test, Cochran-Armitage Trend Test, and log Poisson regression models to compare 6-y egg allergy risk by the frequency of infant egg consumption. RESULTS: The risk of maternal-reported egg allergy at 6 y significantly (P-trend = 0.004) decreased with infant egg consumption frequency at 12 mo: 2.05% (11/537) for infants not consuming eggs, 0.41% (1/244) for those consuming eggs <2 times per wk, and 0.21% (1/471) for those consuming eggs ≥2 times per wk. A similar but nonsignificant trend (P-trend=0.109) was observed for egg consumption at 10 mo (1.25%, 0.85%, and 0%, respectively). After adjusting for socioeconomic confounders, breastfeeding, complementary food introduction, and infant eczema, infants who consumed eggs ≥2 times per wk at 12 mo had a significantly lower RR of maternal-reported egg allergy at 6 y (confounder-adjusted RR: 0.11; 95% CI: 0.01, 0.88; P = 0.038), whereas those who consumed <2 times per wk (confounder-adjusted RR: 0.21; 95% CI: 0.03, 1.67; P = 0.141) did not have a significantly lower risk than those who did not consume eggs at all. CONCLUSIONS: Consumption of eggs ≥2 times per wk in late infancy is associated with a reduced risk of developing egg allergy later in childhood.

Delayed egg introduction beyond infancy and increased egg allergy risk in childhood.

AIM: Egg is a major food allergen in childhood. Recent studies suggest that early introduction of allergenic foods can decrease the risk of developing egg allergy. The impact of early egg introduction in the general population is unclear. We examined associations between age of infant egg introduction and childhood egg allergy outcomes in a general population. METHODS: The study population consisted of 1217 neonates from Project Viva, a longitudinal pre-birth cohort in eastern Massachusetts area, USA. Mothers reported age of infant egg introduction and child egg allergy using questionnaires and specific IgE to egg white was assayed. We estimated associations between age of infant egg introduction and egg allergy outcomes using Log-binomial regression models, adjusting for socio-demographics and health confounders. RESULTS: Egg allergy at 2 years was significantly higher (8.0% vs. 1.4%, P < 0.0001) in children who had delayed egg introduction beyond infancy, compared with children who were introduced to egg during infancy (adjusted relative risk or aRR 7.58; 95% CI 3.08, 18.61). At 12 years, the risk of egg allergy remained significantly higher (3.9% vs. 1.1%, P = 0.048) in children with delayed egg introduction compared with children introduced to egg during infancy (aRR 4.07; 95% CI 1.20, 13.87). CONCLUSIONS: Infants with delayed introduction of eggs after 12 months had increased risk of egg allergy in childhood (2 years) and the relationship persisted in early adolescence (12 years). Our findings suggest that introduction to eggs before 12 months could contribute to the prevention of egg allergy.

HTKS-Kids: A tablet-based self-regulation measure to equitably assess young children's school readiness.

Background: Technology advances make it increasingly possible to adapt direct behavioral assessments for classroom use. This study examined children's scores on HTKS-Kids, a new, largely child-led version of the established individual research assessment of self-regulation, Head-Toes-Knees-Shoulders-Revised task (HTKS-R). For the HTKS-Kids tablet-based assessment, which was facilitated by children's preschool teachers, we examined (1) preliminary reliability and validity; (2) variation in scores predicted by child age and background characteristics; and (3) indication that HTKS-Kids provides different information from teacher ratings of children. Method: Participants included n = 79 4-year-old children from two urban areas in upstate New York, USA. Average parent education was 12.5 years, ranging 3-20. A researcher administered the HTKS-R to individual children, and teachers (eight white, two Latino) were trained to use the HTKS-Kids tablet-based assessment and asked to play once with each study child. Teachers also rated each child on 10 Child Behavior Rating Scale (CBRS) items about classroom self-regulation. Results: We found evidence that (1) the HTKS-Kids captures variation in children's self-regulation and correlates positively with established measures, (2) parent education was the best predictor of HTKS-Kids scores, and (3) teachers rated Black children significantly worse and white children better on the CBRS, with the magnitude of group differences similar to the contribution of parent education. In contrast, Black and white children showed no score differences on HTKS-Kids. Implications: The HTKS-Kids is a promising new tablet-based assessment of self-regulation that could replace or supplement traditional teacher ratings, which are often subject to implicit bias.

Infant age at egg introduction and malnutrition-related child growth in the United States.

To evaluate the relationship between infant age of egg introduction and malnutrition-related growth outcomes in the United States, we analysed secondary data of 1716 mother-child dyads in the Infant Feeding Practices Study II and its Year 6 Follow-Up Study. Malnutrition-related growth outcomes included body mass index z-score (BMIZ), obesity (weight-for-height z-score [WHZ] ≥3 or BMIZ ≥ 2), WHZ, wasting (WHZ < -2), height-for-age z-score (HAZ), and stunting (HAZ < -2). Infant age at egg introduction was analysed as a continuous variable. We used generalised estimating equations to estimate the mean difference in continuous outcomes and relative risk [RR]) for binary outcomes, adjusting for related maternal and child confounders. We also explored interactions with child sex, maternal race/ethnicity, maternal educational level, ever breastfeeding, and formula feeding. In the total sample, a later infant age at egg introduction was associated with a lower mean difference in HAZ (confounder-adjusted mean difference = -0.08, 95% confidence interval [CI]: -0.12 to -0.03 per month) and a higher risk of stunting (confounder-adjusted RR = 1.17, 95% CI: 1.03-1.33 per month) at 6 years. The associations between infant age at egg introduction and 12-month growth outcomes differed by child sex. Among females but not among males, later introduction of eggs was associated with a lower mean WHZ (-0.06 [-0.12 to 0.00] per month) at 12 months. Later egg introduction during infancy was associated with a lower mean HAZ and a higher risk of stunting in 6-year-old children. Besides this, it was associated with a lower WHZ among females at 12 months.

The Head-Toes-Knees-Shoulders Revised: Links to Academic Outcomes and Measures of EF in Young Children.

The measurement of self-regulation in young children has been a topic of great interest as researchers and practitioners work to help ensure that children have the skills they need to succeed as they start school. The present study examined how a revised version of a commonly used measure of behavioral self-regulation, the Head-Toes-Knees-Shoulders task (HTKS) called the HTKS-R, and measures of executive function (EF) was related to academic outcomes between preschool and kindergarten (ages 4-6years) in a diverse sample of children from families with low income participating in Head Start in the United States. Participants included 318 children (53% female; 76% White; and 20% Latino/Hispanic) from 64 classrooms in 18 Head Start preschools who were followed over four time points between the fall of preschool and the spring of kindergarten. Results indicated that children with higher HTKS-R scores had significantly higher math and literacy scores at all-time points between preschool and kindergarten. The HTKS-R was also a more consistent predictor of math and literacy than individual EF measures assessing inhibitory control, working memory, and task shifting. Parallel process growth models indicated that children who had high initial scores on the HTKS-R also had relatively higher initial scores on math and literacy. In addition, growth in children's scores on the HTKS-R across the preschool and kindergarten years was related to growth in both children's math and literacy scores over the same period independent of their starting points on either measure. For the HTKS-R and math, children's initial scores were negatively associated with growth over the preschool and kindergarten years indicating that lower skilled children at the start of preschool started to catch up to their more skilled peers by the end of kindergarten.

Developmental Relations Among Motor and Cognitive Processes and Mathematics Skills.

This study explored transactional associations among visuomotor integration, attention, fine motor coordination, and mathematics skills in a diverse sample of one hundred thirty-five 5-year-olds (kindergarteners) and one hundred nineteen 6-year-olds (first graders) in the United States who were followed over the course of 2 school years. Associations were dynamic, with more reciprocal transactions occurring in kindergarten than in the later grades. Specifically, visuomotor integration and mathematics exhibited ongoing reciprocity in kindergarten and first grade, attention contributed to mathematics in kindergarten and first grade, mathematics contributed to attention across the kindergarten year only, and fine motor coordination contributed to mathematics indirectly, through visuomotor integration, across kindergarten and first grade. Implications of examining the hierarchical interrelations among processes underlying the development of children's mathematics skills are discussed.

Visuomotor integration and inhibitory control compensate for each other in school readiness.

Visuomotor integration (VMI), or the ability to copy designs, and 2 measures of executive function were examined in a predominantly low-income, typically developing sample of children (n = 467, mean age 4.2 years) from 5 U.S. states. In regression models controlling for age and demographic variables, we tested the interaction between visuomotor integration (design copying) and inhibitory control (pencil-tap) or verbal working memory (digit span) on 4 directly assessed academic skills and teacher-reported approaches to learning. Compared with children with both poor visuomotor integration and low inhibitory control, those on the higher end of the continuum in at least 1 of these 2 skills performed better across several dependent variables. This compensatory pattern was evident for longitudinal improvement in print knowledge on the Test of Preschool Early Literacy (TOPEL), with similar though marginally significant findings for improvement in phonological awareness (TOPEL) and teacher-rated approaches to learning on the Preschool Learning Behaviors Scale (PLBS). Of note, the same compensatory pattern emerged for concurrently measured receptive vocabulary on the Peabody Picture Vocabulary Test (PPVT), expressive vocabulary on the Woodcock-Johnson III (WJ), TOPEL phonological awareness, and teacher-rated approaches to learning. The consistent pattern of results suggests that strong visuomotor integration skills are an important part of school readiness, and merit further study.

A Rasch Analysis of the KeyMath-3 Diagnostic Assessment.

Effectively assessing children's academic development can help school professionals make placement decisions and prepare appropriate instructional supports. The KeyMath-3 Diagnostic Assessment (Connolly, 2008) is a widely used assessment of children's mathematical abilities; however, despite much use, the measurement properties of the KeyMath-3 DA have not been examined, aside from the development and standardization phases. The current study conducted a Rasch analysis of the Basic Concepts content area of the KeyMath-3 DA in a diverse sample of 308 young children to assess the quality of the assessment. Rasch analytic procedures examined unidimensionality, item and person fit statistics, reliability, and item hierarchy. Misfitting items were further examined, and response patterns were modified. In general, results show that the Basic Concepts subscale is a good measure of the underlying construct of young children's understanding of the basic concepts in mathematics. Implications are discussed.

Predictors of early growth in academic achievement: the head-toes-knees-shoulders task.

Children's behavioral self-regulation and executive function (EF; including attentional or cognitive flexibility, working memory, and inhibitory control) are strong predictors of academic achievement. The present study examined the psychometric properties of a measure of behavioral self-regulation called the Head-Toes-Knees-Shoulders (HTKS) by assessing construct validity, including relations to EF measures, and predictive validity to academic achievement growth between prekindergarten and kindergarten. In the fall and spring of prekindergarten and kindergarten, 208 children (51% enrolled in Head Start) were assessed on the HTKS, measures of cognitive flexibility, working memory (WM), and inhibitory control, and measures of emergent literacy, mathematics, and vocabulary. For construct validity, the HTKS was significantly related to cognitive flexibility, working memory, and inhibitory control in prekindergarten and kindergarten. For predictive validity in prekindergarten, a random effects model indicated that the HTKS significantly predicted growth in mathematics, whereas a cognitive flexibility task significantly predicted growth in mathematics and vocabulary. In kindergarten, the HTKS was the only measure to significantly predict growth in all academic outcomes. An alternative conservative analytical approach, a fixed effects analysis (FEA) model, also indicated that growth in both the HTKS and measures of EF significantly predicted growth in mathematics over four time points between prekindergarten and kindergarten. Results demonstrate that the HTKS involves cognitive flexibility, working memory, and inhibitory control, and is substantively implicated in early achievement, with the strongest relations found for growth in achievement during kindergarten and associations with emergent mathematics.

Fine motor skills and executive function both contribute to kindergarten achievement.

This study examined the contribution of executive function (EF) and multiple aspects of fine motor skills to achievement on 6 standardized assessments in a sample of middle-socioeconomic status kindergarteners. Three- and 4-year-olds' (n=213) fine and gross motor skills were assessed in a home visit before kindergarten, EF was measured at fall of kindergarten, and Woodcock-Johnson III Tests of Academic Achievement were administered at fall and spring. Correlations indicated that EF and fine motor skills appeared distinct. Further, controlling for background variables, higher levels of both EF and fine motor skills, specifically design copy, predicted higher achievement on multiple subtests at kindergarten entry, as well as improvement from fall to spring. Implications for research on school readiness are discussed.

Self-regulation and academic achievement in elementary school children.

Self-regulation is a key construct in children's healthy and adaptive development. In this chapter, the authors situate self-regulation in a theoretical context that describes its underlying components that are most important for early school success: flexible attention, working memory, and inhibitory control. The authors review evidence that supports substantive links between these aspects of self-regulation and academic achievement in young children. They also discuss methodological challenges in reliably and validly assessing these skills (involving measures that are biased, are not applicable across broad age ranges, or triangulated) and describe some recent advances in measures of self-regulation (involving the NIH Toolbox or the Head-Toes-Knees-Shoulders assessment) that are reliable, ecologically valid, and predictive of children's school achievement.

Effects of classroom organization on letter-word reading in first grade.

Teacher organization is a crucial part of classroom functioning; however, its relation to student achievement has not been investigated as extensively as that of instruction. In this study, organization is defined as the amount of time teachers spend explaining the purpose and procedures of learning activities and daily routines. Data from first-grade classrooms (N=44) observed three times during the school year (fall, winter, and spring) are analyzed, along with students' (N=108) literacy skills at fall and spring. Hierarchical Linear Modeling reveals that, controlling for students' fall word reading and vocabulary skills, as well as amount of language arts instruction they receive, both amount and change in amount over time in classroom organization significantly predicts spring word reading skills. Specifically, children in classrooms observed in higher amounts of classroom time in organization at the beginning of the school year, followed by sharp decreases over the school year, demonstrated stronger letter and word reading skills by spring, and this was a main effect (p<.05). Practical and research implications are discussed.

Links between behavioral regulation and preschoolers' literacy, vocabulary, and math skills.

This study investigated predictive relations between preschoolers' (N=310) behavioral regulation and emergent literacy, vocabulary, and math skills. Behavioral regulation was assessed using a direct measure called the Head-to-Toes Task, which taps inhibitory control, attention, and working memory, and requires children to perform the opposite of what is instructed verbally. Hierarchical linear modeling (HLM) was utilized because children were nested in 54 classrooms at 2 geographical sites. Results revealed that behavioral regulation significantly and positively predicted fall and spring emergent literacy, vocabulary, and math skills on the Woodcock Johnson Tests of Achievement (all ps<.05). Moreover, growth in behavioral regulation predicted growth in emergent literacy, vocabulary, and math skills over the prekindergarten year (all ps<.05), after controlling for site, child gender, and other background variables. Discussion focuses on the role of behavioral regulation in early academic achievement and preparedness for kindergarten.

Women in child development: themes from the SRCD Oral History Project.

Research in child development has emerged as a major intellectual discipline and a topic of great interest and importance to society. The Society for Research in Child Development (SRCD) has been the leading scholarly society concerned with the advancement of this research. As part of its focus on a history of the field, the SRCD has undertaken an oral history project in which prominent members are interviewed. Of the 102 completed interviews, 47 are women's accounts, which document important contributions women have made to child development. The experiences reported by individual participants reflect themes in the general history of women in psychology and child development during the early and mid-1900s. Women encountered obstacles to their efforts, even as they were supported by others and struggled to achieve prominence amid the sometimes ambiguous or conflicting circumstances that characterized women's entry into child development.