Risk factors for developmental vulnerability: Insight from population-level surveillance using the Early Development Instrument.

Objectives: Population-level studies may elucidate the most promising intervention targets to prevent negative outcomes of developmental vulnerability in children. This study aims to bridge the current literature gap on identifying population-level developmental vulnerability risk factors using combined social and biological/health information. Methods: This study assessed developmental vulnerability among kindergarten children using the 2016 Early Development Instrument (EDI) and identified risk factors of developmental vulnerability using EDI data cross-linked to a population-wide administrative health dataset. A total number of 23,494 children aged 5-6 were included (48% female). Prenatal, neonatal, and early childhood risk factors for developmental vulnerability were investigated, highlighting the most important ones contributing to early development. Results: The main risk factors for developmental vulnerability were children with a history of mental health diagnosis (risk ratio = 1.46), biological sex-male (risk ratio = 1.51), and poor socioeconomic status (risk ratio = 1.58). Conclusion: Our study encompasses both social and health information in a populational-level representative sample of Alberta, Canada. The results confirm evidence established in other geographic regions and jurisdictions and demonstrate the association between perinatal risk factors and developmental vulnerability. Based on these results, we argue that the health system should adopt a multilevel prevention and intervention strategy, targeting individual, family, and community together.

Psychometric properties and factor structure of the early development instrument in a sample of Jordanian children.

BACKGROUND: Investing in children's early years can have a lasting positive effect, such as better academic outcomes throughout their school careers. In Jordan, investments have been made in early childhood development and early childhood care and education to improve children's school readiness. School readiness comprises a range of abilities needed to succeed in school, including physical, emotional, social, and cognitive skills. To measure the impact of these investments on children's school readiness, Jordan has been implementing the Early Development Instrument (EDI), a population-level, teacher-completed checklist of children's school readiness, assessing children's development in five main areas, referred to as domains. METHODS: The goal of the current study was to examine the psychometric properties of the Arabic version of the EDI, using data collected in 2018 on a sample of 5952 children in Jordan. The EDI was translated from the original English version to Arabic and adapted for use in Jordan. We conducted a categorical confirmatory factor analysis (CFA) for each of the five domains of the EDI and examined the reliability of the domains and subdomains using Cronbach's alpha reliability coefficient. RESULTS: With few exceptions, the study results are in line with those of the analysis of the psychometric properties found with the original, Canadian English version of the EDI in a population of Canadian children. Results of CFAs demonstrated, for the most part, good model fits. Internal consistency indices of the domains ranged from 0.60 for physical health and well-being to 0.96 for social competence. For the subdomains, they ranged from 0.26 to 0.94. CONCLUSIONS: Our results provide empirical support for the adaptation of the EDI for population monitoring of school readiness in Jordan. Validation of the Arabic adaptation opens up the possibility of assessing school readiness of young children in Jordan in comparison to the many other countries that have successfully adapted and applied the EDI.

Use of administrative record linkage to measure medical and social risk factors for early developmental vulnerability in Ontario, Canada.

BACKGROUND: Linkage of demographic, health, and developmental administrative data can enrich population-based surveillance and research on developmental and educational outcomes. Transparency of the record linkage process and results are required to assess potential biases. OBJECTIVES: To describe the approach used to link records of kindergarten children from the Early Development Instrument (EDI) in Ontario to health administrative data and test differences in characteristics of children by linkage status. We demonstrate how socio-demographic and medical risk factors amass in their contribution to early developmental vulnerability and test the concordance of health diagnoses in both the EDI and health datasets of linked records. METHODS: Children with records in the 2015 EDI cycle were deterministically linked to a population registry in Ontario, Canada. We compared sociodemographic and developmental vulnerability data between linked and unlinked records. Among linked records, we examined the contribution of medical and social risk factors obtained from health administrative data to developmental vulnerability identified in the EDI using descriptive analyses. RESULTS: Of 135,937 EDI records, 106,217 (78.1%) linked deterministically to a child in the Ontario health registry using birth date, sex, and postal code. The linked cohort was representative of children who completed the EDI in age, sex, rural residence, immigrant status, language, and special needs status. Linked data underestimated children living in the lowest neighbourhood income quintile (standardized difference [SD] 0.10) and with higher vulnerability in physical health and well-being (SD 0.11) , social competence (SD 0.10), and language and cognitive development (SD 0.12). Analysis of linked records showed developmental vulnerability is sometimes greater in children with social risk factors compared to those with medical risk factors. Common childhood conditions with records in health data were infrequently recorded in EDI records. CONCLUSIONS: Linkage of early developmental and health administrative data, in the absence of a single unique identifier, can be successful with few systematic biases introduced. Cross-sectoral linkages can highlight the relative contribution of medical and social risk factors to developmental vulnerability and poor school achievement.

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.