Population-Based Teacher-Rated Assessment of Anxiety Among Canadian Kindergarten Children.

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.

Screen time and developmental health: results from an early childhood study in Canada.

BACKGROUND: Research has shown that longer hours of screen time are negatively associated with children's healthy development. Whereas most research has focused on school-age children, less is known about this association in early childhood. To fill this gap, we examined the association between screen time and developmental health in preschool-aged children. METHODS: This study draws from a data linkage on children (N = 2983; Mean age = 5.2, SD = 0.3 years, 51% male) in British Columbia (BC), Canada, who entered Kindergarten in public elementary schools in 2019. Parent reports on children's screen time, health behaviors, demographics, and family income collected upon kindergarten entry (09/2019), were linked to teacher reports on children's developmental health, collected halfway through the school year (02/2020). Screen time was assessed with the Childhood Experiences Questionnaire. Developmental vulnerability versus developmental health in five domains (physical, social, emotional, language and cognition, and communication skills) was measured with the Early Development Instrument. RESULTS: Logistic regression analyses using generalized estimating equation showed that children with more than one hour of daily screen time were more likely to be vulnerable in all five developmental health domains: physical health and wellbeing (odds ratio [OR] =1.41; 95% confidence interval [CI], 0.99 - 2.0; p=0.058), social competence (OR=1.60; 95% CI, 1.16 - 2.2; p=0.004), emotional maturity (OR=1.29; 95% CI, 0.96 - 1.73; p=0.097), language and cognitive development (OR=1.81; 95% CI, 1.19 - 2.74; p=0.006) and communication skills (OR=1.60; 95% CI, 1.1 - 2.34; p=0.015) compared to children reporting up to one hour of screen time/day. An interaction effect between income and screen time on developmental health outcomes was non-significant. Results were adjusted for child demographics, family income, and other health behaviors. CONCLUSIONS: Daily screen time that exceeds the recommended one-hour limit for young children, as suggested by the Canadian 24-h Movement Guidelines for Children and Youth (Tremblay et al. BMC Public Health. 17:874, 2017; Tremblay J Physical Activity Health. 17:92-5, 2020) is negatively associated with developmental health outcomes in early childhood. Screen-based activities should thus be limited for young children. Future research needs to examine the underlying mechanisms through which screen time is linked to developmental vulnerabilities.

Engagement, Innovation, and Impact in a Dietitian Contact Centre: The EatRight Ontario Experience.

Purpose: EatRight Ontario (ERO), a multi-modal dietitian service (phone, email, web), provided the public and health intermediaries with healthy eating advice, professional support, and health promotion tools from 2007 to 2018. An evaluation of ERO was conducted to assess the impact of the model on knowledge, attitudes, and behaviour for consumers, utilization, and support levels and satisfaction provided to health intermediaries. Methods: Consumer clients were sent a survey 1-4 weeks after using the ERO service to capture self-reported dietary changes, intentions, nutritional knowledge, and satisfaction. Health intermediaries were recruited through an electronic ERO newsletter and asked about how ERO supported their practice. Results: Of the 867 consumer respondents, 92% had either made a change or indicated that information from ERO confirmed their present behaviour, and 96% indicated they would recommend the services to others. Of the 337 health intermediaries who responded 71% indicated that ERO provided services they could not deliver. Conclusions: ERO's multi-modal dietitian contact centre provides a model for implementing successful remote service access for consumers and professionals to support healthy eating across diverse demographics and geographies, including those in geographically underserved areas.

Disentangling the role of income in the academic achievement of migrant children.

Poverty has a well-established association with poor developmental outcomes in children but is often found to be a weak predictor of outcomes for migrant children. Building on theory focused on the developmental competencies of minority children, the current study used a systematic and novel analytic approach to disentangle the relationship between income and developmental outcomes for different groups of migrant children. Utilizing a population-based cohort of children in British Columbia, Canada (N = 23,154), the study examined whether income differently predicted the kindergarten to Grade 7 (K-7) literacy and numeracy trajectories of migrant children (economic, family, and refugee groups), in comparison to non-migrants. By applying Group-Based Trajectory Modeling (GBTM), the study found that lower income was generally associated with lower K-7 literacy and numeracy achievement trajectories. The relationship between income and achievement did not differ for migrant children in comparison to non-migrant children, with the exception of one sub-group of high-achieving economic class migrant children, which appeared to be less impacted by low income levels. Follow-up binomial logistic regression analysis found that parental education levels at migration and English language ability predicted which migrant children would be high literacy and numeracy achievers despite low income. The results suggest that basic associations between poverty and the outcomes of migrant children mask an underlying complexity: For most migrant children, poverty was just as predictive of detrimental academic outcomes as it was for non-migrant children and being in the exceptional sub-group of high-achieving, low-income migrant children was partly accounted for by other protective factors.

Children of chronically ill parents: Relationship between parental multiple sclerosis and childhood developmental health.

BACKGROUND: Exposure to parental chronic illness is associated with adverse developmental outcomes. OBJECTIVE: We examined the association between parental multiple sclerosis (MS) and parental MS-related clinical factors on developmental health. METHODS: We conducted a population-based cohort study in British Columbia, Canada, using linked health databases. The outcome was childhood development at 5 years of age, expressed as vulnerability on the Early Development Instrument (EDI). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. RESULTS: MS-affected parents (n = 783) were older, more likely to be English speakers, and had higher rates of mental health morbidity (39.6% vs 22.2%, p < 0.001) than unaffected parents (n = 2988). In the adjusted models, children of mothers with MS (aOR = 0.62, 95% CI = 0.44-0.87), but not children of the fathers with MS, had a lower risk of vulnerability on the social development domain of the EDI. However, mental health comorbidity (aOR = 1.62, 95% CI = 1.05-2.50) and physical comorbidity (aOR = 1.67, 95% CI = 1.05-2.64) among mothers with MS were associated with increased vulnerability on the EDI. CONCLUSION: Maternal MS, but not paternal MS, was associated with lower rates of developmental vulnerability on the social development domain. However, mental and physical comorbidity among MS-affected mothers were associated with increased developmental vulnerability in children.

Childhood poverty and school readiness: Differences by poverty type and immigration background.

Objectives: Poverty exposes children to adverse conditions that negatively impact development. However, there is limited understanding on how different types of poverty may affect children of various immigration backgrounds differently in outcomes such as school readiness. This study examined these relationships between household and/or neighbourhood poverty, poverty timing, and immigration background with school readiness outcomes at kindergarten. Methods: This study utilized a retrospective, population-based cohort of administrative records linked with surveys completed by kindergarten teachers for 15 369 children born in British Columbia, Canada. The exposures investigated were neighbourhood poverty (residing in a neighbourhood in the lowest income-quintile) and/or household poverty (receiving a health insurance subsidy due to low household income). Experiencing both neighbourhood and household poverty simultaneously was defined as "combined" household and neighbourhood poverty. The outcome of vulnerability on school readiness domains was assessed at kindergarten (47.8% female; mean age = 6.01 years) using teacher ratings on the Early Development Instrument (EDI). Results: Children exposed to combined poverty between age 0 and 2 had greater odds of being vulnerable in two or more domains of school readiness than children not exposed to any poverty during this period (adjusted odds ratio (aOR) = 2.07, 95% CI: [1.74; 2.47], p < 0.001). The effect of combined poverty was larger than household poverty only (aOR = 1.54, 95% CI: [1.31; 1.82], p < 0.001) or neighbourhood poverty only (aOR = 1.49, 95% CI: [1.30; 1.70], p < 0.001). Combined poverty was associated with negative outcomes regardless of timing. Both non-immigrants (aOR = 2.40, 95% CI: [1.92; 3.00], p < 0.001) and second-generation immigrants (aOR = 1.63, 95% CI: [1.22; 2.17], p < 0.001) experiencing combined poverty scored lower on school readiness. Conclusions: Children who experienced combined poverty had lower levels of school readiness at kindergarten, regardless of timing and immigration background.

Neighbourhood-level socioeconomic status and prevalence of teacher-reported health disorders among Canadian kindergarten children.

Background: The evidence on the association between neighborhood-level socioeconomic status (SES) and health disorders in young children is scarce. This study examined the prevalence of health disorders in Canadian kindergarten (5-6 years old) children in relation to neighborhood SES in 12/13 Canadian jurisdictions. Methods: Data on child development at school entry for an eligible 1,372,980 children out of the total population of 1,435,428 children from 2004 to 2020, collected using the Early Development Instrument (EDI), were linked with neighborhood sociodemographic data from the 2006 Canadian Census and the 2005 Taxfiler for 2,058 neighborhoods. We examined the relationship using linear regressions. Children's HD included special needs, functional impairments limiting a child's ability to participate in classroom activities, and diagnosed conditions. Results: The neighborhood prevalence of health disorders across Canada ranged from 1.8 to 46.6%, with a national average of 17.3%. The combined prevalence of health disorders was 16.4%, as 225,711 children were identified as having at least one health disorder. Results of an unadjusted linear regression showed a significant association between neighborhood-level SES and prevalence of health disorders (F(1, 2051) = 433.28, p < 0.001), with an R2 of 0.17. When province was added to the model, the R2 increased to 0.40 (F(12, 2040) = 115.26, p < 0.001). The association was strongest in Newfoundland & Labrador and weakest in Ontario. Conclusion: Our study demonstrated that the prevalence of health disorders among kindergarten children was higher in lower SES neighborhoods and varied by jurisdiction in Canada, which has implications for practice and resource allocation.

Population-Level Data on Child Development at School Entry Reflecting Social Determinants of Health: A Narrative Review of Studies Using the Early Development Instrument.

BACKGROUND: The Early Development Instrument (EDI) was developed as a population-level assessment of children's developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children's developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations. METHODS: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children's developmental health and contribute knowledge in the area of early childhood development. RESULTS: A number of studies have examined the association between several social determinants of health and children's developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries. CONCLUSIONS: The ability of the EDI to monitor children's developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.

Teacher-Reported Prevalence of FASD in Kindergarten in Canada: Association with Child Development and Problems at Home.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention.

The economic costs of early vulnerability in Canada.

OBJECTIVE: The study estimates the economic costs of early vulnerability in the light of population-level data showing that between 25% and 30% of Canadian children do not arrive at kindergarten meeting all of the developmental benchmarks they need to thrive both now and into the future. METHODS: The study examines Early Development Instrument (EDI) data across Canada as of 2008/09, and across time within British Columbia since 2001. We then link the BC EDI data with school achievement results on standardized tests in grades four and seven, along with graduation records and criminal justice information. RESULTS: The result is a synthetic cohort with which we can simulate the impact on economic growth of reducing early vulnerability in BC from its current rate of 29% to 10%, a threshold above which child vulnerability is biologically unnecessary. DISCUSSION: Nearly three times what it should be, a rate of early vulnerability that approaches 30% signals that the country now tolerates an unnecessary brain drain that will dramatically deplete our future stock of human capital. Economic analyses reveal that this depletion will cause Canada to forgo 20% in GDP (gross domestic product) growth over the next 60 years. The economic value of this loss is equivalent to investing $2.2 trillion to $3.4 trillion today at a rate of 3.5% interest, even after paying for the social investment required to reduce vulnerability.

Socioeconomic gradient in the developmental health of Canadian children with disabilities at school entry: a cross-sectional study.

OBJECTIVE: To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities. DESIGN: Cross-sectional study using population-level database of children's developmental health at school entry (2002-2014). SETTING: 12 of 13 Canadian provinces/territories. MEASURES: Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains. ANALYSIS: Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health. RESULTS: All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (ß (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (ß (SE): 0.12 (0.01)). CONCLUSIONS: The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes.

Sex differences in the socioeconomic gradient of children's early development.

Sex differences in early child development (ECD) are well documented, as is the socioeconomic status (SES) gradient in early development outcomes. However, relatively little is known about whether the SES gradient in ECD outcomes varies by sex. This study examines whether the association between neighbourhood SES and developmental health outcomes of Canadian kindergarten children is different for girls than for boys. Individual-level child development data, collected using the Early Development Instrument (EDI), were combined with neighbourhood-level socioeconomic data from Statistics Canada's Census and Tax Filer databases. Using an SES index comprising 10 socioeconomic variables, we show a significant cross-level interaction between neighbourhood SES and sex in relation to children's developmental outcomes: the neighbourhood SES gradient in child outcomes is steeper for males than for females. This finding was consistent across all five developmental domains measured by the EDI, for overall developmental health, and across geographical regions in Canada. Further research using family-level SES data, data from multiple time points and countries, and qualitative studies would help to further contextualize the observed interactions.

A Pan-Canadian Data Resource for Monitoring Child Developmental Health: The Canadian Neighbourhoods and Early Child Development (CanNECD) Database.

The Canadian Neighbourhoods and Early Child Development (CanNECD) database is a unique resource for research on child developmental health and well-being within the socioeconomic and cultural context of Canadian neighbourhoods. This paper describes the CanNECD database and highlights its potential for advancing research at the intersection of child development, social determinants of health, and neighbourhood effects. The CanNECD database contains cross-sectional population-level child developmental health data from all across Canada collected through regional implementation of the Early Development Instrument (EDI), geo-coded information on residential neighbourhoods covering all of Canada, and socioeconomic and demographic variables from the Canada Census and Income Taxfiler database. Individuals are not identified in the database, as no identifying information, such as names and addresses, is attached to the EDI record. At data collection, each individual child is given a unique number which is a combination of site, school, and position on a class list. Each neighbourhood receives a unique identifier which then is linkable across datasets. The nearly 800,000 EDI records spanning 2003-2014 and representing all Canadian provinces and territories (with the exception of Nunavut) are compiled in a secure electronic collection system at the Offord Centre for Child Studies, McMaster University in Hamilton, Canada. Early studies using the EDI demonstrated its utility as a tool for assessing child developmental health at a population level, and its potential for both community-level and large-scale monitoring of child populations. Research using the CanNECD database is now examining to what extent social determinants and the steepness of the social gradients of developmental health differ between geographical jurisdictions and between different sub-populations. We are also working to identify outlier neighbourhoods in which EDI scores are substantially higher or lower than predicted by a neighbourhood's demographic and socioeconomic characteristics, and exploring other potentially important determinants of children's developmental health. Finally, we are examining the extent to which change-over-time in aggregate EDI scores varies geographically, and how well it coincides with changes in socioeconomic factors. Thus, the CanNECD database offers the opportunity for research that will inform national policies and strategies on child developmental health.

Establishing a protocol for building a pan-Canadian population-based monitoring system for early childhood development for children with health disorders: Canadian Children's Health in Context Study (CCHICS).

INTRODUCTION: Health disorders early in life have tremendous impact on children's developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally representative data on the social determinants of early childhood development for children with health disorders. Evidence from Canada and other countries indicate that poorer developmental outcomes in typically developing children are associated with lower socioeconomic status (SES). However, to date, it is not known whether this relationship is stronger among children with health disorders. The study's objectives are to estimate the prevalence and to investigate social determinants of developmental outcomes for young children with health disorders, using the Early Development Instrument (EDI). METHODS AND ANALYSIS: Study objectives will be achieved through three steps. First, using existing EDI data for 10 provinces and 2 territories collected from 2004 to 2015, we will investigate differences in developmental health outcomes among children with identified health disorders. Second, population-level EDI data will be linked with neighbourhood sociodemographic census data to explore associations between socioeconomic characteristics and rates of specific diagnoses among children aged 5-6 years, including trends over time. Third, for 3 of these 12 regions, additional health and/or education databases will be linked at an individual level. These data will be used to establish differences in EDI outcomes in relation to the age-of-onset of diagnosis, and presence of intervention or treatment. ETHICS AND DISSEMINATION: Study methodologies have been approved by the Hamilton Integrated Research Ethics Board. The results of the analyses of developmental health outcomes for children with health disorders combined with SES will have implications for both health service delivery and school-based intervention strategies. Results will contribute to a framework for public policy.

The Ages and Stages Questionnaire: Latent factor structure and growth of latent mean scores over time.

BACKGROUND: Very little research exists that looks at the Ages and Stages Questionnaire simultaneously from a modern latent variable point of view and by looking at its psychometric properties over time. AIMS: To explore the latent factor structure of the ASQ using Exploratory Structural Equation Modeling techniques for ordinal data and investigate its change over time using the method of vertical scaling from multidimensional Item Response Theory. STUDY DESIGN: Longitudinal, with the same children being assessed at multiple timepoints. SUBJECTS: Children measured using the 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48month questionnaires of the ASQ. Initial sample (12months) consisted of 2219 children and final sample (48months), 892 children due to drop-out. OUTCOME MEASURES: Ages and Stages Questionnaire, 3rd version (ASQ-3). RESULTS: Results indicate that all ASQ-3 age questionnaires examined showed the proposed 5-factor structure (except the 12-month version) but with different patterns over time. The Gross Motor domain had the fewest misfitting items, from 12months onwards. The Personal-Social domain and the Problem Solving domain had larger numbers of misfitting items. Results from the vertical scaling analysis showed that both the Problem-Solving and Personal-Social dimensions also exhibited the most complex patterns of change over time. CONCLUSIONS: The psychometric properties of the ASQ-3 seem to be both time-dependent and domain-dependent. Earlier questionnaires reflect a latent structure that was not as well-defined as for later versions. Also, domains such as Communication and Gross Motor appear to be much more reliably measured than others, such as Problem-Solving and Personal-Social.

Neighbourhood socioeconomic status indices and early childhood development.

The developmental health of young children is highly influenced by the socioeconomic conditions in which they are raised. How to accurately measure these conditions is a point of debate in the current literature on child development, health, and social determinants. We have evaluated four existing indices of socioeconomic status (SES) to determine the most relevant for the analysis of early childhood development (ECD) in Canada. Following a literature review of published SES indices which used 2006 Canadian Census data, four indices were chosen based on their relevance to ECD and the number of citations in subsequent articles. These were: the Canadian Deprivation Index, the Socioeconomic Factor Index, the Canadian Marginalization Index and an index created by the Early Childhood Mapping Project in Alberta, Canada. The indices were replicated using SES data for 2038 customized geographic neighbourhoods encompassing 99.9% of the Canadian population, and the relationship of the indices to ECD was investigated by linking to aggregated data from the Early Development Instrument (EDI), a teacher-completed questionnaire used to assess kindergarten children's physical, social, emotional, and cognitive development, and communication skills. The derived SES indices were compared based on four criteria: the input variables used, the index structure, the interpretability of the index and the variance they explained (R2) in the different EDI outcome measures. In terms of variance explained, material components of the SES indices (e.g., income, education) consistently showed the strongest association with children's language and cognitive development. The patterns of association for the non-material SES components and the other developmental domains of the EDI were more complex. We discuss the findings in regard to current developments in the field, and the need for refining empirical and theoretical approaches to examine associations between different facets of SES contextual factors and different aspects of ECD outcomes.

Examining the social determinants of children's developmental health: protocol for building a pan-Canadian population-based monitoring system for early childhood development.

INTRODUCTION: Early childhood is a key period to establish policies and practices that optimise children's health and development, but Canada lacks nationally representative data on social indicators of children's well-being. To address this gap, the Early Development Instrument (EDI), a teacher-administered questionnaire completed for kindergarten-age children, has been implemented across most Canadian provinces over the past 10 years. The purpose of this protocol is to describe the Canadian Neighbourhoods and Early Child Development (CanNECD) Study, the aims of which are to create a pan-Canadian EDI database to monitor trends over time in children's developmental health and to advance research examining the social determinants of health. METHODS AND ANALYSIS: Canada-wide EDI records from 2004 to 2014 (representing over 700,000 children) will be linked to Canada Census and Income Taxfiler data. Variables of socioeconomic status derived from these databases will be used to predict neighbourhood-level EDI vulnerability rates by conducting a series of regression analyses and latent variable models at provincial/territorial and national levels. Where data are available, we will measure the neighbourhood-level change in developmental vulnerability rates over time and model the socioeconomic factors associated with those trends. ETHICS AND DISSEMINATION: Ethics approval for this study was granted by the Behavioural Research Ethics Board at the University of British Columbia. Study findings will be disseminated to key partners, including provincial and federal ministries, schools and school districts, collaborative community groups and the early childhood development research community. The database created as part of this longitudinal population-level monitoring system will allow researchers to associate practices, programmes and policies at school and community levels with trends in developmental health outcomes. The CanNECD Study will guide future early childhood development action and policies, using the database as a tool for formative programme and policy evaluation.

Selection of area-level variables from administrative data: an intersectional approach to the study of place and child development.

Given data limitations, neighborhood effects scholarship relies heavily on administrative data to measure area-level constructs. We provide new evidence to guide the selection of indicators from routinely collected sources, focusing on effects on early child development. Informed by an analytic paradigm attuned to the intersection of race, class, and sex, along with population-level data in British Columbia, Canada, our findings signal the need for greater precision when choosing variables in place of the now dominant approaches for measuring constructs like income/wealth, employment, family structure and race/ethnicity. We also provide new evidence about which area-level variables associate with the different domains of child development, as well as how area-level associations vary across urban and rural contexts.