Prenatal and Early Life Factors that Predict Risk for Developmental Problems: A Longitudinal Cohort...
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Prenatal and Early Life Factors that Predict Risk for Developmental Problems: A Longitudinal Cohort Study Suzanne Tough PhD 1,2 , Jodi Siever MSc 3 , Karen Benzies 4 , Shirley Leew 5 , David Johnston 1,6 1 Department of Paediatrics, University of Calgary, 2 Department of Community Health Sciences, University of Calgary, 3 Public Health Innovation and Decision Support, Alberta Health Services, 4 Faculty of Nursing, University of Calgary, 5 Decision Support Research Team, Alberta Health Services, 6 Behavioral Research Unit, Alberta Children’s Hospital To describe features of children who screened at high risk of developmental problems at school entry Mothers (n=791) who had been followed since the prenatal period were mailed a questionnaire when their child was 4-6 years of age. Primary Outcome Risk for developmental problems measured using The Parents’ Evaluation of Developmental Status (PEDS) (internal consistency = 0.81; test-retest reliability=0.88; inter-rater reliability=0.88)) • Other Data • Maternal physical and emotional health (SF-8) • Maternal social support (Medical Outcomes Study Social Support Scale) • Parenting sense of competence and morale (Parenting Sense of Competence Scale and Parenting Morale Index) • Parenting supports and resources • Child behaviour, communication, and self-control (Child Social Competence Scale) • Health care utilization and referrals • All participants provided informed consent Special thanks to Upstart! (formerly the Calgary Children’s Initiative) for their ongoing support of the CPC follow-up work. Background Variable Odds Ratio 95% C.I. p- v a l u e Child Male 2.3 (1.3, 4. 1) 0.005 Mother History of abuse, reported at pregnancy 2.4 (1.3, 4. 4) 0.006 Poor parenting morale, when child was 3 yrs 3.9 (2.1, 7. 3) <0.001 Child Mother Predicted probabili ty of screening at high risk Gender History of Abuse, reported at pregnancy Parenting Morale, when child was 3 yrs Male Yes Poor 0.35 Male No Good 0.13 Girl Yes Poor 0.24 Girl No Good 0.07 The findings are best generalized to middle and high income families in urban settings. (About three- quarters of Canadian families with kids under 6 have a comparable income). Maternal well-being and history of abuse are related to risk for developmental problems at school entry. These risks factors were similar to those identified when children were 3 years of age, suggesting maternal well-being has a influence on child development through the early part of childhood. Recruitment & Participation Path A Path B Path C Path E 15% 31% 35% 19% Path Definition, Recommended Action A high risk of developmental problems B moderate risk of problems C low risk of developmental problems but elevated risk for mental health problems D moderate risk of developmental problems, problems with parental communication E low risk of developmental problems and mental health problems Characteristic N=491 % Mothers (mean age 36.3 yrs) Married 473 95.0 Income > $40,000 427 87.7 More than high school education 409 83.6 Children (mean age 5.0 yrs) Male 240 48.9 In the past year… Had a routine health exam 394 80.7 Saw a dentist 436 89.0 Had vision tested 261 53.8 Had hearing tested 58 12.0 Mother and Child Characteristics Objective Methods 300 did not return the questionnaire 791 women who participated in the first follow up study were mailed a survey 491 returned the questionnaire (62% participation) • 11 refused to take the survey • 4 were ineligible (2 out of country, 2 had second child in the survey) • 227 did not return the questionnaire • 58 not contactable by phone Conclusions Better understand how women’s well- being during pregnancy and early childhood can be optimized. Identify women with a history of abuse and determine what strategies can support their well-being and parenting. Ongoing research and evaluation of such strategies. Continue to follow-up this cohort to understand the impact of maternal well-being on middle childhood development. Recommendations Results of Developmental Screening at Age 5 Paths on the Parents’ Evaluation of Development Status (PEDS) Key Predictors for screening at high risk for developmental problems on the PEDS (Path A) Selected Predicted Probabilities for screening at high risk for developmental problems on the PEDS (Path A), from the multinomial logistic regression model Understanding the long term influence of early life events on child development can inform strategies to identify children and families at risk
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Transcript of Prenatal and Early Life Factors that Predict Risk for Developmental Problems: A Longitudinal Cohort...
Prenatal and Early Life Factors that Predict Risk for Developmental Problems: A Longitudinal Cohort Study
Suzanne Tough PhD1,2, Jodi Siever MSc3, Karen Benzies4, Shirley Leew5, David Johnston1,6
1Department of Paediatrics, University of Calgary, 2Department of Community Health Sciences, University of Calgary, 3Public Health Innovation and Decision Support, Alberta Health Services, 4Faculty of Nursing, University of Calgary, 5Decision Support Research Team, Alberta Health Services, 6Behavioral Research Unit, Alberta Children’s Hospital
To describe features of children who screened at high risk of developmental problems at school entry
Mothers (n=791) who had been followed since the prenatal period were mailed a questionnaire when their child was 4-6 years of age.
Primary Outcome Risk for developmental problems measured using The Parents’ Evaluation of
Developmental Status (PEDS) (internal consistency = 0.81; test-retest reliability=0.88; inter-rater reliability=0.88))
• Other Data• Maternal physical and emotional health (SF-8)• Maternal social support (Medical Outcomes Study Social Support Scale)• Parenting sense of competence and morale (Parenting Sense of Competence Scale and Parenting
Morale Index)• Parenting supports and resources• Child behaviour, communication, and self-control (Child Social Competence Scale)• Health care utilization and referrals• All participants provided informed consent
Special thanks to Upstart! (formerly the Calgary Children’s Initiative) for their ongoing
support of the CPC follow-up work.
Background
VariableOdds Ratio
95% C.I. p-value
Child
Male 2.3 (1.3, 4.1) 0.005
Mother
History of abuse, reported at pregnancy
2.4 (1.3, 4.4) 0.006
Poor parenting morale, when child was 3 yrs
3.9 (2.1, 7.3) <0.001
Child MotherPredicted probability
of screening at high risk
Gender
History of Abuse,
reported at pregnancy
Parenting Morale, when child was 3
yrs
Male Yes Poor 0.35
Male No Good 0.13
Girl Yes Poor 0.24
Girl No Good 0.07
The findings are best generalized to middle and high income families in urban settings. (About three-quarters of Canadian families with kids under 6 have a comparable income).
Maternal well-being and history of abuse are related to risk for developmental problems at school entry.
These risks factors were similar to those identified when children were 3 years of age, suggesting maternal well-being has a influence on child development through the early part of childhood.
Recruitment & Participation
Path A
Path BPath C
Path E
15%
31%
35%
19%
Path Definition, Recommended Action
A high risk of developmental problems
B moderate risk of problems
C low risk of developmental problems but elevated risk for mental health problems
D moderate risk of developmental problems, problems with parental communication
E low risk of developmental problems and mental health problems
Characteristic N=491 %
Mothers (mean age 36.3 yrs)
Married 473 95.0
Income > $40,000 427 87.7
More than high school education
409 83.6
Children (mean age 5.0 yrs)
Male 240 48.9
In the past year…
Had a routine health exam 394 80.7
Saw a dentist 436 89.0
Had vision tested 261 53.8
Had hearing tested 58 12.0
Mother and Child Characteristics
Objective
Methods
300 did not return the questionnaire
791 women who participated in the first follow up study were
mailed a survey
491 returned the questionnaire
(62% participation) • 11 refused to take the survey
• 4 were ineligible (2 out of country, 2 had second child in the survey)
• 227 did not return the questionnaire
• 58 not contactable by phone
Conclusions
Better understand how women’s well-being during pregnancy and early childhood can be optimized.
Identify women with a history of abuse and determine what strategies can support their well-being and parenting.
Ongoing research and evaluation of such strategies.
Continue to follow-up this cohort to understand the impact of maternal well-being on middle childhood development.
Recommendations
Results of Developmental Screening at Age 5
Paths on the Parents’ Evaluation of Development Status (PEDS)
Key Predictorsfor screening at high risk for developmental
problems on the PEDS (Path A)
Selected Predicted Probabilitiesfor screening at high risk for developmental
problems on the PEDS (Path A), from the multinomial logistic regression model
Understanding the long term influence of early life events on child development can inform strategies to identify children and families at risk
