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Predictive value of preschool surveillance in detecting learning difficulties
N Corrigan1, M Stewart, M Scott
1North and West Belfast Community Paediatric Unit, Belfast.
Insights
Child health surveillance (CHS) showed poor sensitivity in detecting mild to moderate learning difficulties, with only 6% identified preschool. Risk factors identified by CHS could not accurately predict these learning disorders.
Area of Science:
- Child Health Surveillance
- Developmental Pediatrics
- Learning Difficulties
Background:
- The Hall report emphasized early detection of mild to moderate learning difficulties through child health surveillance (CHS).
- Preschool CHS aims to identify children with developmental and learning disorders.
- Assessing the effectiveness of CHS in early recognition of learning difficulties is crucial.
Purpose of the Study:
- To examine the efficacy of preschool child health surveillance (CHS) in the early recognition of children with mild to moderate learning difficulties.
- To evaluate the sensitivity of CHS in detecting learning difficulties.
- To identify predictive factors for learning difficulties within the CHS framework.
Main Methods:
- Retrospective case-control study design.
- Inclusion of 408 children with mild to moderate learning difficulties and 2406 birth records/150 child health records as controls.
- Analysis of perinatal and preschool variables using logistic regression.
Main Results:
- Prevalence of mild to moderate learning difficulties was 16% in the study area.
- CHS identified only 6% of children with learning difficulties during the preschool period.
- Perinatal factors (lower social class, prematurity, male sex) and preschool variables (speech delay, poor parenting, behavior problems) were associated with learning difficulties, but a predictive model was inaccurate.
Conclusions:
- Preschool child health surveillance (CHS) in North and West Belfast (1983-1989) demonstrated low sensitivity for detecting mild to moderate learning difficulties, despite high coverage.
- An accurate predictive model for learning difficulties could not be developed using documented CHS risk factors.
- Improvements in CHS sensitivity and predictive modeling are needed for early identification of learning difficulties.
Objectives:
The Hall report specified the early detection of mild to moderate learning difficulties as one aim of child health surveillance (CHS). This study examines the efficacy of preschool CHS in the early recognition of children with these disorders.
Design:
A retrospective case-control study.
Subjects:
All children (n = 408) with mild to moderate learning difficulties born between 1 July 1983 and 30 June 1984 and resident in North and West Belfast.
Controls:
2406 birth records and 150 full child health records controlled for age and geographical area.
Results:
The prevalence of mild to moderate learning difficulties in North and West Belfast was 16%. Only 6% of children with learning difficulties were identified by the CHS in the preschool period, although the detection rate for children eventually requiring placement in schools for moderate learning difficulties was better. Coverage of the CHS ranged from 90% at the 2 year examination to 98% at the 4 year examination. Perinatal variables associated with learning difficulties after multiple logistic regression analysis were lower social class (odds ratio (OR) 3.9), prematurity < 35 weeks (OR 3.0), male sex (OR 1.6), and birth to an unmarried mother (OR 0.6). Independent preschool variables identified by the CHS were speech delay (OR 3.3), poor parenting skills (OR 4.0), behaviour problems (OR 2.8), enuresis (OR 2.4), poor visual acuity (OR 1.8), and otitis media with effusion (OR 1.4). A statistical model for the early detection of learning difficulties using these risk factors is unable to predict accurately the children who will develop mild to moderate learning difficulties.
Conclusions:
The CHS as it existed from 1983 to 1989 in North and West Belfast was poorly sensitive to the detection of mild to moderate learning difficulties despite excellent coverage. An accurate predictive model for learning difficulties could not be developed from the risk factors documented by the CHS.