Primary care screening visits for young children serve as useful sources of data for assessing social and developmental markers. It is not clear how these screening data can be used to predict whether children are school ready.
A new study appeared in JAMA Pediatrics that explored associations between school district early Kindergarten Readiness Assessment (KRA) and electronic health records (EHR) data and linked KRA scores with the changes occurring during the coronavirus disease 2019 (COVID-19) pandemic.
Childhood is a watershed period for developing social skills, healthy physical and brain development, and becoming ready for school. Multiple factors may interfere with the acquisition of these skills which are essential in school life, such as social training, emotional regulation, as well as math and literacy skills. These may include socioeconomic and racial characteristics.
In some regions, up to 4 out of 10 new kindergartners are not ready to enter school. Since there has been no systematic attempt to identify which children are at risk of entering kindergarten without readiness, it is not clear how and which risk factors can be modified to change this situation.
The COVID-19 pandemic negatively impacted learning in school-age children, but its effect on development in children under five years remains to be described. This motivated the current study that uses KRA scores before and during the pandemic with the EHR data from a cohort of students in a large school district with about 36,000 students.
The KRA scores are linked to reading proficiency in the third grade and include four skill categories: preliteracy, premath, motor skills, and social-emotional skills.
What did the study show?
The study included over 3,000 patients who were screened at primary care level. The mean age was 67 months, with the majority being Black (80%) vs 8% Whites. The passing KRA score was set at 270.
When correlated with the pandemic dates, the mean KRA scores were significantly lower in 2021, at 260, vs ~263 in 2019 and 2018. About a fifth of students scored above passing levels in 2021, demonstrating school readiness, vs ~30% in 2019 and 32% in 2018.
About one in four parents said they rarely read to their child, that is, one or less days a week, at least once during the period of the study. About 27% of children were unable to meet ASQ scores at least once, while 12% of the children sometimes experienced food insecurity.
The risk factors for a low KRA score were one or more failures in the ASQ between 18 and 54 months, being Hispanic, not speaking the language of the healthcare professional during screening visits, being male and being seldom read to, as well as having food insecurity. Only 23% of boys were school-ready vs 32% of girls.
Having Medicaid insurance, indicative of low socioeconomic status, was associated with school readiness in ~27% of children, vs ~51% if Medicaid was never used.
Other socioeconomic factors, like housing insecurity, race, depression among the caregivers, and difficulty of any sort in obtaining benefits, did not show an association with the KRA scores.
“To interpret our findings using a hypothetical clinical example, starting with the expected score of 270.8 in the adjusted model (equivalent to demonstrating readiness): a boy who is Medicaid insured, who once failed an ASQ, who infrequently reported food insecurity, and was not read to as an infant lost an average of 15 points on the KRA, placing him in bottom category of emerging readiness (score below 257).”
What are the implications?
This is among the earliest studies to report that there might have been “a deleterious association of the COVID-19 pandemic with early learning and development.” It is also one of the largest studies to correlate primary care data to outcomes in public schools.
While other researchers have found conflicting evidence regarding childhood development during the pandemic, multiple factors have been at work, impacting the validity of observed associations. For example, school enrolment was lower during the period. However, the association of lower school readiness with not being read to as an infant has been well documented, as well as with low developmental scores and food insecurity.
Danger signals picked up in this way could help provide appropriate interventions in early life, whether by speech and language therapy, promoting learning by enrolment in good early childhood education programs, or facilitating library access.
“These findings suggest substantial untapped potential for primary care pediatrics and school districts to work more closely together given that risks for kindergarten readiness are evident much earlier in primary care.”