Educational Outcomes for Children at 7 to 9 Years of Age After Birth at 39 vs 40 to 42 Weeks' Gestation.

Importance: Birth at 39 weeks' gestation is common and thought to be safe for mother and neonate. However, findings of long-term outcomes for children born at this gestational age have been conflicting. Objective: To evaluate the association of birth at 39 weeks' gestation with childhood numeracy and literacy scores at ages 7 to 9 years compared with birth at 40 to 42 weeks' gestation. Design, Setting, and Participants: In this Australian statewide, population-based cohort study using a causal inference framework based on target trial emulation, perinatal data on births between January 1, 2005, and December 31, 2011, were linked to educational outcomes at 7 to 9 years of age. Statistical analyses were performed from December 2022 to June 2023. Exposure: Birth at 39 weeks' gestation compared with birth at 40 to 42 weeks' gestation. Main Outcomes and Measures: Numeracy and literacy outcomes were assessed at 7 to 9 years of age using Australian National Assessment Program-Literacy and Numeracy data and defined by overall z score across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy). Multiple imputation and doubly robust inverse probability weighted regression adjustment were used to estimate population average causal effects. Results: The study population included 155 575 children. Of these children, 49 456 (31.8%; 24 952 boys [50.5%]) were born at 39 weeks' gestation and were compared with 106 119 (68.2%; 52 083 boys [49.1%]) born at 40 to 42 weeks' gestation. Birth at 39 weeks' gestation was not associated with altered educational outcomes for children aged 7 to 9 years compared with their peers born at 40 to 42 weeks' gestation (mean [SE] z score, 0.0008 [0.0019] vs -0.0031 [0.0038]; adjusted risk difference, -0.004 [95% CI, -0.015 to 0.007]). Each educational domain was investigated, and no significant difference was found in grammar and punctuation (risk difference [RD], -0.006 [95% CI, -0.016 to 0.005]), numeracy (RD, -0.009 [95% CI, -0.020 to 0.001]), spelling (RD, 0.001 [95% CI, -0.011 to 0.0013]), reading (RD, -0.008 [95% CI, -0.019 to 0.003]), or writing (RD, 0.006 [95% CI, -0.005 to 0.016]) scores for children born at 39 weeks' gestation compared with those born at 40 to 42 weeks' gestation. Birth at 39 weeks' gestation also did not increase the risk of scoring below national minimum standards in any of the 5 tested domains. Conclusions and Relevance: Using data from a statewide linkage study to emulate the results of a target randomized clinical trial, this study suggests that there is no evidence of an association of birth at 39 weeks' gestation with numeracy and literacy outcomes for children aged 7 to 9 years.

Longitudinal Associations Between COVID-19 Stress and the Mental Health of Children With ADHD.

OBJECTIVE: To investigate the longitudinal associations between COVID-19 induced stress (related to COVID-19 restrictions/changes), attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional symptoms, and mental health outcomes (negative affect, anxiety, depression, and irritability) in children with ADHD during the COVID-19 pandemic. METHOD: Parents of 140 Australian children with ADHD (aged 5-17 years) completed an online survey in May 2020 during stay-at-home restrictions and 12-months later. RESULTS: Baseline COVID-19 stress was associated with increased total ADHD symptom severity (ß = .21, p = .007) and hyperactivity/impulsivity symptoms (ß = .23, p = .002) at 12-months, after accounting for covariates (i.e., child age, gender, ADHD medication, socio-economic status, and baseline symptoms). Despite some indication of associations between baseline COVID-19 stress and 12-month oppositional symptoms and negative affect, these were attenuated when adjusting for baseline symptoms. CONCLUSIONS: The study provides initial evidence of the medium-term impacts of pandemic-related stress for children with ADHD.

Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence.

Importance: Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear. Objective: To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence. Design, Setting, and Participants: This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022. Exposures: Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC). Main Outcomes and Measures: Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist. Results: A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa. Conclusions and Relevance: There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.

School-age outcomes among IVF-conceived children: A population-wide cohort study.

BACKGROUND: In vitro fertilisation (IVF) is a common mode of conception. Understanding the long-term implications for these children is important. The aim of this study was to determine the causal effect of IVF conception on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. METHODS AND FINDINGS: Causal inference methods were used to analyse observational data in a way that emulates a target randomised clinical trial. The study cohort comprised statewide linked maternal and childhood administrative data. Participants included singleton infants conceived spontaneously or via IVF, born in Victoria, Australia between 2005 and 2014 and who had school-age developmental and educational outcomes assessed. The exposure examined was conception via IVF, with spontaneous conception the control condition. Two outcome measures were assessed. The first, childhood developmental vulnerability at school entry (age 4 to 6), was assessed using the Australian Early Developmental Census (AEDC) (n = 173,200) and defined as scoring <10th percentile in ≥2/5 developmental domains (physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, communication skills, and general knowledge). The second, educational outcome at age 7 to 9, was assessed using National Assessment Program-Literacy and Numeracy (NAPLAN) data (n = 342,311) and defined by overall z-score across 5 domains (grammar and punctuation, reading, writing, spelling, and numeracy). Inverse probability weighting with regression adjustment was used to estimate population average causal effects. The study included 412,713 children across the 2 outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC, and 8,976 cases and 333,335 controls for NAPLAN. There was no causal effect of IVF-conception on the risk of developmental vulnerability at school-entry compared with spontaneously conceived children (AEDC metrics), with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7 to 9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, with an adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF- and spontaneously conceived children. The models were adjusted for sex at birth, age at assessment, language background other than English, socioeconomic status, maternal age, parity, and education. Study limitations included the use of observational data, the potential for unmeasured confounding, the presence of missing data, and the necessary restriction of the cohort to children attending school. CONCLUSIONS: In this analysis, under the given causal assumptions, the school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived children. These findings provide important reassurance for current and prospective parents and for clinicians.

Associations Between Anxiety and Home Learning Difficulties in Children and Adolescents with ADHD During the COVID-19 Pandemic.

The COVID-19 pandemic has markedly impacted functioning for children and adolescents including those with attention-deficit/hyperactivity disorder (ADHD). We explored home learning difficulties (HLD) during COVID-19 restrictions in Australian children (aged 5-17) with ADHD, aiming to: (1) describe home learning experiences, and (2) examine associations between child anxiety (i.e., concurrent anxiety symptoms and pre-existing anxiety disorder status) and HLD. Baseline data from the longitudinal ADHD COVID-19 Survey were used (n = 122). Parents reported on school factors and HLD; pre-existing anxiety and co-occurring difficulties; anxiety, ADHD, and oppositional symptoms; demographics; and medications. Parents retrospectively reported more children often looked forward to school pre-pandemic, than during the pandemic. Anxiety symptoms, but not pre-existing anxiety disorder status, were associated with HLD after accounting for covariates. ADHD inattention symptoms were also associated with HLD. Results support recommendations to continue pre-pandemic supports to assist with ADHD symptoms during home learning, and strategies/supports for families are discussed.

Supporting children's mental health in primary schools: a qualitative exploration of educator perspectives.

Schools are often seen as a key setting for the provision of mental health support for children. This study aimed to explore the professional perspectives of primary school educators in Victoria, Australia, regarding how schools can support the mental health of their students. Semi-structured interviews and focus groups were conducted with 17 primary school educators, from four schools. Thematic analysis was used to generate themes from the data. This study indicates that educators report significant concerns about the complexities of their role and their capacity to support children's mental health due to a lack of resources, overwhelming demands, and inadequate training. Educators highlighted the importance of partnership and communication with families and of a school culture that prioritises mental health. This study provides insights into external factors that can undermine effective support of children's mental health within primary schools and indicates a need for a more integrated approach to supporting children's mental health across education and healthcare.

Developmental Outcomes for Children After Elective Birth at 39 Weeks' Gestation.

Importance: Elective births at 39 weeks' gestation are increasing. While this option may improve maternal and perinatal outcomes compared with expectant management, longer-term childhood developmental outcomes are uncertain. Objective: To investigate the association between elective birth at 39 weeks' gestation and the risk of childhood developmental vulnerability. Design, Setting, and Participants: For this cohort study, 2 causal inference analyses were conducted using Australian statewide, population-based data. Perinatal data from births between January 1, 2005, and December 31, 2013, were linked to childhood developmental outcomes at age 4 to 6 years (assessed using multiple imputation via inverse probability-weighted regression adjustment). Data analyses were conducted between September 7 and November 9, 2021. Exposures: Two exposure groups were considered: (1) elective birth between 39 weeks and 0 days' and 39 weeks and 6 days' gestation vs expectant management and (2) birth via induction of labor vs planned cesarean delivery among those born electively at 39 weeks' gestation. Main Outcomes and Measures: Childhood developmental vulnerability at school entry, defined as scoring below the 10th percentile in at least 2 of 5 developmental domains (physical health and well-being, social competence, emotional maturity, school-based language and cognitive skills, and communication skills and general knowledge). Results: Of 176 236 births with linked outcome data, 88 165 met the inclusion criteria. Among these, 15 927 (18.1%) were elective births at 39 weeks' gestation (induction of labor or planned cesarean delivery), and 72 238 (81.9%) were expectantly managed with subsequent birth between 40 and 43 weeks' gestation. Compared with expectant management, elective birth at 39 weeks' gestation was not associated with an altered risk of childhood global developmental vulnerability (adjusted relative risk [aRR], 1.03; 95% CI, 0.96-1.12) or with developmental vulnerability in any of the individual domains. In an analysis restricted to elective births at 39 weeks' gestation, induction of labor (n = 7928) compared with planned cesarean delivery (n = 7999) was not associated with childhood developmental vulnerability (aRR, 0.96; 95% CI, 0.82-1.12) or with vulnerability in any individual domains. Conclusions and Relevance: In this cohort study, elective birth at 39 weeks' gestation was not associated with childhood developmental vulnerability. For those born electively at 39 weeks' gestation, birth after induction of labor or by elective cesarean delivery had similar developmental outcomes.

A preliminary examination of key strategies, challenges, and benefits of remote learning expressed by parents during the COVID-19 pandemic.

Among the many impacts of the Coronavirus disease (COVID-19) pandemic, one of the most dramatic was the immediate closure of in-person schooling in March/April 2020 when parents were faced with much greater responsibility in supporting their children's learning. Despite this, few studies have examined parents' own perspectives of this experience. The aims of this preliminary study were to (a) identify challenges, benefits, and useful strategies related to remote learning and (b) examine differences in findings across two countries, between parents of youth with and without attention-deficit/hyperactivity disorder (ADHD), and between parents of children and adolescents. To address these aims, parent responses to open-ended questions on the Home Adjustment to COVID-19 Scale (HACS; Becker, Breaux, et al., 2020) were examined across three studies conducted in the United States and Australia (N = 606, children: 68.5% male, ages 6-17 years). The challenges most frequently expressed by parents included the child's difficulty staying on task (23.8% of parents), lack of motivation (18.3%), remote learning factors (17.8%), and lack of social interaction (14.4%). The most frequently expressed strategy related to using routines and schedules (58.2%) and the biggest benefit was more family time (20.3%). Findings were largely consistent across countries, ADHD status, and age, with a few notable group differences. Given that the most common challenges involved child- (e.g., difficulties with staying on task and motivation), parent- (e.g., balancing remote learning with work responsibilities), and school- (e.g., remote instruction difficulties) related factors, there is a need for improved support across these systems going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Educational Gap for Children with ADHD and Subthreshold ADHD.

OBJECTIVE: The present study examined the impact of Attention Deficit Hyperactivity Disorder (ADHD) on core educational outcomes in two large community cohorts of Australian school children. METHOD: Academic (reading and numeracy) and non-academic (school engagement, attendance, peer victimization, and parental expectations) outcomes were compared between children with ADHD, subthreshold ADHD, and controls when children were in grade 5 (M age = 10.5). Data were drawn from the Longitudinal Study of Australian Children birth cohort (LSAC; N = 3,540) and the Children's Attention Project (CAP; N = 356). RESULTS: Both subthreshold ADHD and ADHD groups had poorer outcomes on all measures, with medium effects sizes. Differences were not evident between subthreshold ADHD and ADHD groups. CONCLUSIONS: Educational outcomes examined in this study highlight the educational risk for upperprimary school children with ADHD or subthreshold ADHD, in comparison to their peers. Monitoring these outcomes is necessary to inform policy, practice, and intervention.

Physical Health, Media Use, and Mental Health in Children and Adolescents With ADHD During the COVID-19 Pandemic in Australia.

OBJECTIVE: To examine the impact of COVID-19 restrictions among children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Parents of 213 Australian children (5-17 years) with ADHD completed a survey in May 2020 when COVID-19 restrictions were in place (i.e., requiring citizens to stay at home except for essential reasons). RESULTS: Compared to pre-pandemic, children had less exercise (Odds Ratio (OR) = 0.4; 95% CI 0.3-0.6), less outdoor time (OR = 0.4; 95% 0.3-0.6), and less enjoyment in activities (OR = 6.5; 95% CI 4.0-10.4), while television (OR = 4.0; 95% CI 2.5-6.5), social media (OR = 2.4; 95% CI 1.3-4.5), gaming (OR = 2.0; 95% CI 1.3-3.0), sad/depressed mood (OR = 1.8; 95% CI 1.2-2.8), and loneliness (OR = 3.6; 95% CI 2.3-5.5) were increased. Child stress about COVID-19 restrictions was associated with poorer functioning across most domains. Most parents (64%) reported positive changes for their child including more family time. CONCLUSIONS: COVID-19 restrictions were associated with both negative and positive impacts among children with ADHD.

Ear Infection Trajectories and Academic, Behavioral, and Quality-of-Life Outcomes: A Population-Based Longitudinal Study.

OBJECTIVE: The purpose of this study was to investigate (1) typical trajectories of parent-reported ear infections throughout childhood and (2) their associations with child outcomes. METHOD: Design and participants: Two parallel cohorts assessed biennially from 2004 to 2014 spanning ages 0-1 to 10-11 years (B cohort, n = 3721) and ages 4-5 to 14-15 years (K cohort, n = 3489) in the Longitudinal Study of Australian Children. Ear infection: Parent-reported ongoing ear infections (B: waves 1-6; K: waves 1, 2, 4, and 5). Outcomes (wave 6): National academic standardized test, teacher-reported learning, parent- and teacher-reported behavior, and self-reported quality of life. Analysis: Latent class models identified ear infection trajectories. Linear regression quantified associations between trajectories and outcomes. RESULTS: Four probability trajectories of ear infections emerged in both cohorts: "consistently low" (B 86.2%, K 87.0%), "moderate to low" (5.5%, 9.7%), "low to moderate" (7.0%, 1.5%), and "consistently high" (1.4%, 1.8%). In K cohort, the "consistently high" group had the worst outcomes (effect sizes 0.2-0.8 SDs), with effect sizes largest for psychosocial and language outcomes. "Moderate to low" and "low to moderate" groups showed marginal to no academic associations, although behavior and quality-of-life scores were 0.2 to 0.3 SDs poorer than the "consistently low" group. Similar but attenuated associations were seen in B cohort. CONCLUSION: Sizable adverse adolescent outcomes follow parent reports of persistent ongoing ear infections throughout childhood. Despite a possibility of reverse causation, this suggests that cumulative rather than age-specific ear infections are most important to outcomes. Clinicians may generally be reassuring about ongoing ear infections limited to either early or middle childhood but should proactively identify and manage the small subgroup whose early infections persist throughout the elementary school years.

Sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life: bidirectional associations from early childhood to early adolescence.

STUDY OBJECTIVES: To examine longitudinal, bidirectional associations among behavioral sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life (HRQoL) from early childhood to adolescence in a population sample of Australian children. METHOD: Data were drawn from the Longitudinal Study of Australian Children, a national prospective cohort study with 4983 children participating in the Kindergarten cohort. Data were collected when children were aged 4-5, 6-7, 8-9, 10-11, and 12-13 years. At each study wave, the primary parent (97% mothers) reported on behavioral child sleep problems, internalizing and externalizing symptoms, and HRQoL domains (psychosocial and physical). Cross-lagged structural equation models were used to evaluate bidirectional associations. RESULTS: At nearly every age, behavioral sleep problems were associated with worse subsequent psychosocial and physical HRQoL. Despite bidirectional associations between mental health and HRQoL at many waves, HRQoL domains more strongly predicted later internalizing symptoms, while externalizing symptoms more strongly predicted later HRQoL. Many of the bidirectional associations among sleep, mental health, and HRQoL were found earlier in childhood. CONCLUSIONS: Behavioral sleep problems may forecast later HRQoL psychosocial and physical impairments. Attending to both sleep problems and HRQoL could prevent the progression of internalizing conditions, while a focus on externalizing concerns could prevent the worsening of these symptoms, sleep problems, and HRQoL, particularly during the transition to school.

The Effectiveness of Working Memory Training for Children With Low Working Memory.

OBJECTIVES: Subgroups of children may benefit more from working memory training than others. In this study, we aimed to examine whether response to the Cogmed Working Memory Training program differed for children with low IQ and elevated attention-deficit/hyperactivity disorder, emotional and behavioral symptoms, special health care needs, or by sex. METHODS: We used data from the Memory Maestros trial, a population-based randomized controlled trial of the Cogmed program delivered at school (n = 226) compared to usual teaching (n = 226) in grade 1 children (mean age 6.9 years; SD 0.4) with low working memory. Cogmed comprises 20 to 25 sessions of 45-minute duration over 5 to 7 weeks. Children completed subtests from the Automated Working Memory Assessment to measure change in working memory from baseline to 6 months postrandomization. RESULTS: After training, improved working memory standard scores (>1 SD) from baseline to 6 months were observed for approximately one-third of the children, with more than half maintaining stable scores (within 1 SD). However, similar outcomes were observed for children receiving usual teaching. Differential effect of Cogmed versus usual teaching was evident for children with elevated hyperactivity and/or inattention, who were less likely to show improved visuospatial working memory, but not for other subgroups studied. CONCLUSIONS: Children with elevated hyperactivity and/or inattention were less likely to show clinically meaningful improvement after Cogmed; however, differential effects were not evident for children with low IQ and elevated emotional and behavioral symptoms, special health care needs, or by sex. More research is needed to determine if training can improve working memory and, if so, for whom.

Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being.

BACKGROUND: This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11 years. METHODS: Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement. RESULTS: Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories. CONCLUSIONS: The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.

Health service utilisation and unmet healthcare needs of Australian children from immigrant families: A population-based cohort study.

Compared with most other Organization for Economic Co-operation and Development (OECD) countries, information about the patterns of health service use for children from immigrant families in Australia is currently limited, and internationally, data on unmet healthcare needs are scarce. This study aims to examine the distribution of health service utilisation and unmet healthcare needs for immigrant children aged 10-11 years in Australia. We drew on data from the Longitudinal Study of Australian Children Birth (B; n = 5,107) and Kindergarten (K; n = 4,983) cohorts. The exposure was family immigration background collected at 0-1 (B-cohort) and 4-5 (K-cohort) years. Outcomes were parent-reported child health service use and unmet healthcare needs (defined as the difference between services needed and services received) at 10-11 years. Logistic regression analyses were used to examine associations between family immigration background and health service use/unmet healthcare needs, adjusting for potential confounders. Results showed that one-third of Australian children (B-cohort: 29.0%; K-cohort: 33.4%) came from immigrant families. There were similar patterns of health service use and unmet healthcare needs between children from English-speaking immigrant and Australian-born families. However, children from non-English-speaking immigrant families used fewer health services, including paediatric, dental, mental health and emergency ward services. There was a disparity between the services used when considering children's health needs, particularly for paediatric specialist services (B-cohort: OR = 2.43, 95% CI 1.11-5.31; K-cohort: OR = 2.72, 95% CI 1.32-5.58). Findings indicate that Australian children from non-English-speaking immigrant families experience more unmet healthcare needs and face more barriers in accessing health services. Further effort is needed to ensure that the healthcare system meets the needs of all families.

Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial.

INTRODUCTION: The first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes. METHODS AND ANALYSIS: This cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen's d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted. ETHICS AND DISSEMINATION: Ethics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families. PRE-RESULTS TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12619000326190).

Better support for children with additional health and developmental needs in school settings: Perspectives of education experts.

AIM: Many children start school with additional health and developmental needs (AHDN), yet how best to support these children for optimal outcomes in the school setting is a complex challenge. This study aims to determine the views of education experts on what differentiates the most effective primary schools. METHODS: Qualitative interviews were conducted with nine senior leaders across the education system responsible for managing or improving practice across a range of schools or school regions in Victoria. Using a positive deviance approach, which investigates strategies already implemented in organizations achieving desired outcomes, the semi-structured interviews aimed to elicit instances of perceived good practice that already exists within the school system. Interviews were analysed using inductive content analysis. RESULTS: All education experts reported high variability across schools and suggested a number of factors differentiating those that were most effective at supporting children with AHDN. They included the presence of strong teacher support by the school leadership team; explicit and documented processes to guide the practice of teachers and ensure consistency at a whole school level; inclusive relationships and environments; participation and knowledge sharing between medical, allied health and other stakeholders in the care team; and an evidenced-based approach to allocating resources to programmes and strategies. CONCLUSION: This exploration of instances of good practice can generate novel insights into a complex problem. Current findings suggest a number of potential opportunities for enhancing practice that can be tested in future research. Improving outcomes for this vulnerable and significant group of children will require collaboration across health and education.

Learning outcomes of children with teacher-identified emerging health and developmental needs.

OBJECTIVES: Children's additional health and developmental needs are often first identified by teachers when they begin school. This study estimates the Grade 3 literacy and numeracy outcomes of children with teacher-identified additional needs emerging in the first year of school, including the added burden conferred by socioeconomic disadvantage. METHODS: Population linked data (n = 42,619) were analysed from the Australian Early Development Census, which include teacher reports on children's health and development at school entry, and the National Assessment Program-Literacy and Numeracy, a direct assessment of reading and numeracy skills at Grade 3. Linear regression analyses were used to estimate associations between emerging needs and learning outcomes, adjusted for sociodemographic characteristics. The combined effect of emerging needs and low maternal education (an indicator of socioeconomic disadvantage) on academic outcomes was examined by estimating the relative excess risk due to interaction (RERI). RESULTS: Emerging health and developmental needs at school entry were associated with lower reading (b = -26.86, 95% CI = -29.19, -24.52) and numeracy (b = -24.39, 95% CI = -26.43, -22.35) outcomes at Grade 3. The combined effect of emerging needs and socioeconomic disadvantage was greater than expected when their individual effects are summed (RERI = 0.38, 95% CI 0.22, 0.55 for reading and RERI = 0.27, 95% CI 0.10, 0.43 for numeracy). CONCLUSION: In the current study, emerging health and developmental needs identified by teachers at the outset of schooling were associated with poorer literacy and numeracy skills at Grade 3, and family socioeconomic disadvantage appeared to further amplify this effect. Meeting the needs of these children will require timely and coordinated supports across the health and education systems, particularly for those children who are also disadvantaged.

Sleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age.

OBJECTIVES: To evaluate whether there are distinct childhood sleep problem trajectories from birth to 10-11 years and to assess associations with cumulative socio-ecological risks (child, family, context). STUDY DESIGN: Participants were 5107 children from the Longitudinal Study of Australian Children-Birth Cohort. At birth, cumulative risk indexes were generated for birth, parenting, family, socioeconomic, and neighborhood risks. Parent-reported child sleep problems were assessed biennially from ages 0-1 to 10-11 years. Sleep problem trajectories were derived using latent class analysis. Multivariable logistic regression was used to examine associations with risk indexes. RESULTS: Five distinct trajectories emerged: persistent sleep problems through middle childhood (7.7%), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%), and no sleep problems (51.9%). Cumulative mother- and father-reported family risks (distress; marital/relational hostility) were linked to nearly all of the trajectories, whereas father- and mother-reported parenting risks were associated with fewer trajectories. Birth risks were associated with increased middle childhood sleep problems. Neighborhood risks were not associated with any trajectories. Socioeconomic risks were linked to mild and persistent sleep problem trajectories. Cumulative risk indexes were most associated with increased middle childhood sleep problems. CONCLUSIONS: This study identified distinct longitudinal sleep problem trajectories, suggesting the need for continuous sleep screening over development. Cumulative risks assessed at birth-primarily maternal and paternal family risks-predicted these trajectories, especially for the sleep problems in middle childhood trajectory. Preventive interventions targeting modifiable factors, particularly caregiver distress and marital/relational hostility, could benefit child sleep.