Patterns of early literacy and word reading skill development across the first 6 months of school and reading instruction.

This study described the growth trajectories of 105 children (n = 55 boys) who had just started primary school in New Zealand (NZ). Children were assessed every fourth school week around 1.5 months after starting school, for five sessions on Dynamic Indicators of Basic Early Literacy Skills first sound fluency (FSF), AIMSweb letter sound fluency (LSF), and a newly created NZ word identification fluency (NZWIF-Y1), designed for alignment with beginning reading instruction in NZ. In addition to progress monitoring tasks, children were assessed at school entry and after progress monitoring on literacy-related criterion measures. All three progress monitoring measures were sensitive to growth over the children's first 6 months of school. Cross-sectional time-series analyses indicated that within-child increases in FSF and LSF were associated with increases in NZWIF-Y1, although FSF did not add unique variance when both FSF and LSF were entered as predictors. Furthermore, growth mixture modeling indicated three latent growth trajectories for each indicator (FSF, LSF, NZWIF-Y1, respectively): Class 1-high initial scores and strong growth over time (72.09%, 55.87%, 22.81%); Class 2-lower initial scores and moderate growth over time (19.18%, 29.12%, 54.30%); and Class 3-low initial scores and limited progress over time (8.73%, 15.00%, 22.89%). Criterion measures assessed prior and after progress monitoring were typically associated with latent class membership. Results suggest relative growth in performance on repeated assessment of early literacy and word reading skills in beginning reading instruction distinguishes groups of students with differential skill acquisition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Kia Timata Pai (Best Start): a study protocol for a cluster randomised trial with early childhood teachers to support children's oral language and self-regulation development.

INTRODUCTION: Oral language skills are associated with children's later self-regulation and academic skills; in turn, self-regulation in early childhood predicts successful functioning later in life. The primary objective of this study is to evaluate the separate and combined effectiveness of an oral language intervention (Enhancing Rich Conversations, ENRICH) and a self-regulation intervention (Enhancing Neurocognitive Growth with the Aid of Games and Exercise, ENGAGE) with early childhood teachers and parents for children's oral language, self-regulation and academic functioning. METHODS AND ANALYSIS: The Kia Timata Pai (Best Start) study is a cluster randomised controlled trial with teachers and children in approximately 140 early childhood centres in New Zealand. Centres are randomly assigned to receive either oral language intervention only (ENRICH), self-regulation intervention only (ENGAGE), both interventions (ENRICH+ENGAGE) or an active control condition. Teachers' and parents' practices and children's oral language and self-regulation development are assessed at baseline at age 1.5 years and approximately every 9 months to age 5, and academic performance at age 6. Teacher-child interactions will also be videotaped each year in a subset of the centres. Children's brain and behaviour development and parent-child interactions will be assessed every 6 months to age 6 years in a subgroup of volunteers. ETHICS AND DISSEMINATION: The Kia Timata Pai trial and the two substudies (Video Project; Brain and Behaviour Development) have been approved by the University of Otago Human Ethics Committee (Health; H20/116), and reviewed for cultural responsiveness by: the Ngai Tahu Research Committee (University of Otago), the Maori Advisory Group (University of Auckland, Liggins Institute) and an internal cultural advisory group. Results will be disseminated in international and national peer-reviewed academic journals and communicated to local, national and international organisations serving early childhood teachers, parents and young children. Data will be available via communication with the corresponding author. TRIAL REGISTRATION NUMBER: ACTRN12621000845831.

School-entry skills and early skill trajectories predict reading after 1 year.

Oral language and early literacy skills are theorized to provide the foundation for reading acquisition. To understand these relations, methods are needed that depict dynamic skill development in the context of reading acquisition. We modeled contributions of school-entry skills and early skill trajectories to later reading with 105 5-year-old children beginning primary school and formal literacy instruction in New Zealand. Children were assessed at school-entry (Preschool Early Literacy Indicators), followed every fourth school week over their first 6 months of school (five probes of First Sound Fluency, Letter Sound Fluency, and New Zealand Word Identification Fluency: Year 1), and after 1 year of school (researcher-administered and school-used indices of literacy-related skills and reading progress). Modified latent change score (mLCS) modeling was used to describe skill development from repeated progress-monitoring data. Ordinal regression and structural equation modeling (path analyses) indicated skills at school-entry and early learning trajectories, indexed by mLCS, predicted children's early literacy progress. Results have implications for research and screening in beginning reading, supporting school-entry screening and progress monitoring of early literacy skills in beginning reading acquisition. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Can sleep questionnaires predict adenotonsillectomy outcome for children with sleep disordered breathing?

INTRODUCTION: Adenotonsillar hypertrophy is the main cause of childhood sleep disordered breathing (SDB) and adenotonsillectomy (TA) the most common treatment. Polysomnography (PSG) for diagnosing SDB is often difficult to obtain with Otolaryngologists usually relying on history and examination when recommending TA. Questionnaires assessing quality of life (QoL) may assist the Otolaryngologists decision making. AIMS: To explore changes in QoL tools following TA for SDB in children aged 3 to 15 with the aim of identifying whether the Pediatric Sleep Questionnaire (PSQ) or Obstructive Sleep Apnoea -18 (OSA-18) is a better predictor of outcome following TA. METHODS: QoL was assessed using OSA-18, PSQ and the Pediatric Quality of Life Inventory™ (PedsQL™). Four groups were recruited from three research databases, those with: SDB, recurrent tonsillitis (RT), SDB and RT, or no disease (controls). Children either received TA or underwent observation. QoL questionnaires were administered at recruitment and 3 months later. Test-retest reliability was assessed using Bland-Altman plots. Pre-intervention scores were plotted against changes in scores, with pre-established cut-offs and cut-offs indicated by control group variability. RESULTS: There were 120 children, 25 had no intervention, and 19 were controls. All questionnaires showed test-retest reliability over time. Using the distribution of scores from the control group we estimated the 95th percentile to redefine the cut-off for OSA-18 (reduced from 60 to 46) and PSQ (unchanged from 0.33). Higher pre-operative scores predicted greater reduction following TA, with OSA-18 the most consistent predictor of QoL change. The PSQ classified 86.8% of children undergoing TA above the 0.33 cut-off; whereas OSA-18 classified 73.7% above the 46 cut-off. Of these, 71.2% and 87.5% showed improvement after TA, respectively. Using the 95% confidence interval for change in the control group to identify a 'meaningful' change in score, children with OSA-18 scores >46 had a 93% chance of a meaningful improvement, whereas PSQ scores >0.33 were associated with an 80% chance of a meaningful improvement. CONCLUSIONS: OSA-18 is a better predictor of improved QoL than PSQ for TA in children with SDB. We propose a new cut off score (>46) for OSA-18. This may assist Otolaryngologists' decision making when assessing a child with SDB.

Sleep-Related Breathing Problem Trajectories Across Early Childhood and Academic Achievement-Related Performance at Age Eight.

Background: Childhood sleep disordered breathing (SDB) has been linked to poorer academic performance; however, research has not investigated the extent improvement in SDB may alter outcomes across key academic skills. This study aimed to investigate if children's early SDB status could predict later academic outcomes, and if an improvement in SDB status across the early childhood years would coincide with better, later performance in key academic skills related to reading, numeracy, and listening comprehension. Methods: Eighty five case children with an SDB symptom score >25 (maximum 77) were matched to 85 control children (score <12) at recruitment (age 3). SDB severity (symptom history and clinical assessment) was evaluated at ages 3, 4, 6, and 8 years and performance on individually-administered academic skills assessed at age 8 (91% retention from age 3). Case children were categorized into "improved" or "not-improved" groups based on SDB trajectories over the 5 years. Contributions of SDB status and trajectory group to academic performance were determined using regression analysis adjusted for demographic variables. Results: History of SDB from age 3 predicted significantly poorer performance on some key academic skills (oral reading and listening skills) at age 8. Children whose SDB improved (45%) performed better in oral reading fluency than those whose SDB did not improve, but difficulties with specific tasks involving oral language (listening retell) remained when compared to controls. Conclusion: Findings support links between early SDB and worse academic outcomes and suggest key academic areas of concern around oral language. Findings highlight the need for child mental health professionals to be aware of children's sleep problems, particularly SDB (past and present), when assessing potential barriers to children's achievement, to assist with appropriate and timely referrals for evaluation of children's sleep difficulties and collaborative evaluation of response to intervention for sleep difficulties.

Sluggish Cognitive Tempo and Daytime Sleepiness Mediate Relationships Between Sleep and Academic Performance.

OBJECTIVE: Sleep difficulties, daytime sleepiness, and sluggish cognitive tempo (SCT) are associated with impairments in academic performance. SCT refers to symptoms of sluggishness, tiredness/lethargy, and slowed thinking/processing, but despite symptom overlap with sleepiness, research examining interrelations of SCT with sleep and daytime sleepiness is limited. The aims of this study were to evaluate the relationship between SCT and daytime sleepiness and to examine pathways between sleep, daytime sleepiness, SCT, and academic performance. METHOD: Participants were a community sample of 1628 parents/caregivers of children aged between 6 and 10 years who completed questionnaires about their child's behavior, sleep, and academic performance. Confirmatory factor analysis was used to examine whether SCT was distinct from daytime sleepiness. Then, structural equation modeling was used to examine direct and indirect pathways between sleep (sleep-disordered breathing [SDB] symptoms, sleep duration, and latency), daytime sleepiness, SCT, and academic performance in reading, writing, and math. RESULTS: SCT and daytime sleepiness were distinct but moderately correlated (r = 0.33, p ≤ 0.001). Sleep, in particular SDB symptoms, predicted increased SCT and daytime sleepiness. SCT was directly and negatively associated with all domains of academic performance, daytime sleepiness was associated with poorer reading performance, and longer sleep duration was directly associated with poorer math performance. SCT and, to a lesser extent, daytime sleepiness mediated effects of sleep on academic performance. CONCLUSION: SCT symptoms are important for understanding how sleep difficulties affect academic performance in children. Sleep, daytime sleepiness, and SCT are interrelated but distinct factors that affect children's academic performance.

Emergent academic skills growth in New Zealand pre-school children undergoing treatment for sleep disordered breathing: a case-control pilot study.

OBJECTIVES: The main objective of this study was to explore the feasibility and treatment sensitivity of measures of preschool oral language and emergent literacy and numeracy for assessing developing skills of preschool children with sleep disordered breathing (SDB) in New Zealand following adenotonsillectomy. METHODS: Eight preschool children aged 3 years 1 month-4 years 5 months were recruited from a surgical waiting list and matched to controls for age (±3 months) and sex. Tasks designed to be sensitive to growth in oral language and emergent literacy and numeracy were reviewed for contextual fit, adapted as necessary for the New Zealand context, and administered before surgery (baseline), three months post-surgery, and at a seven-month follow-up alongside other measures. RESULTS: Growth in oral language and emergent literacy was greater for case children than matched controls, suggesting that the tasks were sensitive to treatment effects. No such effect was observed for early numeracy tasks. Case children had more symptoms of SDB and behavioral and emotional difficulties than matched controls prior to surgery, and improvements were reported in these domains following surgery. CONCLUSIONS: Oral language and emergent literacy measures trialled in the present research showed potential for evaluating treatment outcomes in pre-schoolers with SDB, and provided preliminary evidence that early treatment of SDB could have positive effects on learning in these domains.

Sleep and Sensory Processing in Infants and Toddlers: A Cross-Sectional and Longitudinal Study.

IMPORTANCE: Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. OBJECTIVE: To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. DESIGN: Observational; cross-sectional and longitudinal. SETTING: Community. PARTICIPANTS: Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). OUTCOMES AND MEASURES: Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure-Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. RESULTS: More problematic sleep at age 2.5 yr was associated with more difficulties in social-relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo-2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). CONCLUSIONS AND RELEVANCE: Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. WHAT THIS ARTICLE ADDS: Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.

The role of whanau (New Zealand Maori families) for Maori children's early learning.

The home-learning environment (HLE) is critical for young children's early learning skills, yet little research has focused on HLEs in indigenous communities. This study examined the role of the HLE of 41 whanau (New Zealand Maori families and community) in relation to their young children's (M = 4 years, 4 months) early learning skills. Parents were observed reading a picture book and reminiscing about past events with their children and reported on their cultural affiliation, literacy, and numeracy practices. Children completed vocabulary, narrative, early literacy, early numeracy, and self-regulation tasks. Principal components analyses revealed an early academic skills factor (story comprehension, story memory, phonological awareness, letter recognition, number recognition, counting, and self-regulation) and an oral language skills factor (receptive and expressive vocabulary and story comprehension). Parents' observed book reading and reminiscing correlated with children's early academic skills, and their observed book reading correlated with children's oral language skills. Parent-child reminiscing was a unique, positive predictor of children's early academic skills. Oral narratives such as reminiscing may be a less visible cultural practice that supports children's early learning. Yet reminiscing is a recognized skill within indigenous communities that have a strong emphasis of intergenerational oral transmission of culturally relevant information. Reminiscing is a source of resilience for whanau, and perhaps for other communities around the world, that needs to be highlighted and taken into account for theory and policy about children's early learning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Describing patterns of early literacy skill development in the first year of school and reading instruction in a New Zealand sample.

This study describes trajectories of early literacy skill development of 99 children (n = 55 boys) in their first year of primary school in New Zealand (NZ). Children were assessed twice weekly for 8 weeks on Dynamic Indicators of Basic Early Literacy Skills (DIBELS; Good & Kaminski, 2011) First Sound Fluency (FSF) and AIMSweb Letter Sound Fluency (LSF; Shinn & Shinn, 2002), with other early literacy and beginning reading skills assessed before and after progress monitoring. FSF and LSF growth trajectories were modeled separately. Multilevel modeling indicated improved performance; however, growth mixture modeling indicated 3 growth trajectories (i.e., latent classes; FSF and LSF, respectively): typical (77.6% of children, 65.7%), developing (10.8%, 14.6%), and limited progress (11.6%, 19.7%). Beginning of year screening was sometimes associated with latent class membership, whereas latent class membership differentiated mid- and year-end literacy skills. Results support progress monitoring of early literacy skills within the NZ context to aid earlier identification of children at-risk for difficulties with reading acquisition. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parent report of children's sleep disordered breathing symptoms and limited academic progress in reading, writing, and math.

OBJECTIVES: To estimate via questionnaire within a population sample of New Zealand (NZ) children aged 6-to-10 years, the prevalence of sleep disordered breathing (SDB) and those struggling academically, and to identify individual and shared risk factors (health and demographic) for parent-reported SDB symptoms and academic difficulties. METHODS: In this cross-sectional study, parents/caregivers of children were recruited through schools and social media to complete an online questionnaire covering health and demographic factors, their children's SDB symptoms (Pediatric Sleep Questionnaire; PSQ) and parental ratings of academic performance based on teacher feedback relative to expected progress in the national curriculum (well below/below/at/above) in reading, writing, and math. RESULTS: A total of 1205 children (53% male) aged (mean) eight years two months were included, comprising 79.4% NZ European/other and 15.0% Maori. The survey-weighted prevalence of SDB (based on the PSQ) was 17.5%. This was higher amongst those with academic difficulties rated 'below/well below' expected progress for reading, writing and math (estimated at 24.0%, 31.0% and 27.5% respectively), with increased odds (adjusted odds ratios) for poor progress of 1.9 (95% CI: 1.2, 3.0), 1.8 (95% CI: 1.2, 2.7) and 2.4 (95% CI: 1.6, 3.7) respectively. There were no shared risk factors common to both SDB and academic difficulties identified from multivariate analyses. CONCLUSIONS: The findings suggest that children with parent-reported SDB symptoms may be at high risk for poor progress in reading, writing, and math. Future research could examine whether treatment of SDB reduces barriers to learning and offsets educational risk.

Habitual Snoring at Age 3 Years: Links with Parent-Rated Remembering in Daily Life and Academic Achievement at Age 7 Years.

OBJECTIVE: Habitual snoring in school-aged children is well known to link with poorer cognitive functioning and academic performance, but few studies have explored later developmental outcomes related to snoring initiated in early childhood. The aims of this study were to examine whether habitual snoring at age 3 years predicted perceived memory and academic functioning at age 7 years. METHODS: Parents (n = 460) of children aged 7 years 2 ± 5 months completed a community follow-up survey about their perceptions of their child's sleep and health, memory in daily activities, and academic performance relevant to numeracy and literacy skills. The first survey was completed by 839 parents 4 years prior when children were aged 3 years (54.8% response rate at age 7 years). Parents rated their child's academic performance twice. First, they rated performance based on teachers' feedback relative to national standard ratings for numeracy and literacy, and second, based on their own observations. RESULTS: Children reported to snore habitually at age 3 years received lower memory and academic composite score ratings at age 7 years. Age 3 years habitual snoring history predicted small but significant unique variation in age 7 years memory (p = 0.005), literacy (p < 0.001), and overall achievement ratings (p = 0.016) in regressions controlling for covariates, with evidence suggesting that memory may mediate links between snoring history and academic performance. CONCLUSION: The findings suggest that habitual snoring in early childhood may adversely affect success in beginning schooling. More research is still needed to determine the best time for treatment so that longer-term consequences of sleep-disordered breathing may be prevented.

Parent involvement in beginning primary school: Correlates and changes in involvement across the first two years of school in a New Zealand sample.

This study described the relations of parents' and teachers' beliefs and attitudes to forms of parents' involvement in children's first two years of primary school. Parents of children in their first year of primary school (age 5) were recruited from 12 classrooms within four schools in New Zealand; 196 families participated in their child's first year, and 124 families continued to participate in their child's second school year. Parents completed the Family-Involvement Questionnaire, New Zealand, and we archivally collected parent-documented children's oral reading homework. Teachers' rated helpfulness of parents' involvement at school (level 2) and parents' rated teacher invitations to be involved and their perceived time and energy (level 1) contributed to school-based involvement in Year 1 in multilevel models, with parents' rated teacher invitations for involvement also found to predict Year 1 home-school communication in regression analyses. Contributors to Year 1 child-parent reading in multilevel models included level 1 predictors of two or more adults in the home and parents' perceived time and energy. Longitudinal analyses suggested both consistency and change in each form of involvement from Year 1 to Year 2, with increases in each form of involvement found to be associated with increases in parents' and/or teachers' views about involvement in Year 2 in cross-sectional time-series analyses. Implications for schools wanting to engage families are that parents' involvement in children's schooling may be influenced by parents' perceptions of their capacity, teachers' engagement efforts, and the school's climate for involvement. This is a special issue paper "Family Engagement in Education and Intervention".

Sleep Disordered Breathing and Academic Performance: A Meta-analysis.

BACKGROUND AND OBJECTIVE: Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance. METHODS: Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted. RESULTS: Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance. CONCLUSIONS: Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.

Natural history of snoring and other sleep-disordered breathing (SDB) symptoms in 7-year-old New Zealand children: a follow-up from age 3.

PURPOSE: We aimed to examine the natural history of snoring and associated symptoms in a community sample of New Zealand children at ages 3 and 7 years, and identify factors associated with habitual snoring at age 7 years. METHODS: Parent/s of children (n = 839) who completed the community survey about their child's sleep and breathing at age 3 years were re-contacted via mail 4 years later when children were aged 7 years. Parents were asked to complete a follow-up questionnaire which included items relating to their child's sleep and health, and family demographic information. There was a 54.8% (n = 460) response rate. RESULTS: At follow-up, habitual snoring was prevalent in 9.2% of the sample, similar to the 11.3% reported at age 3 years. However, habitual snoring status changed over time; 36.2% (n = 21/58) remained habitual snorers; 63.8% (n = 37/58) were no longer snoring habitually, while 5.3% (n = 21/397) had started habitual snoring since the initial survey. Overall, the reported severity of SDB-related symptoms decreased over time, regardless of initial habitual snoring status. Nonetheless, habitual snoring at follow-up was significantly associated with mouth breathing, sleeping with the neck extended, sweating profusely, night waking, and parent-reported child irritability. CONCLUSIONS: Our findings highlight the dynamic nature of SDB, where habitual snoring and related symptoms can develop, remain present, or resolve at different times, over early-mid-childhood years. Given the dynamic nature of habitual snoring over the early childhood years, pediatricians should continue to screen for snoring and sleep apnea on an annual basis throughout childhood.

Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea.

AIM: The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds. METHODS: Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively. RESULTS: Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found. CONCLUSIONS: Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship.

Reliability of home-based physiological sleep measurements in snoring and non-snoring 3-year olds.

PURPOSE: To study snoring and non-snoring 3-year olds in their own homes and to establish reference values and night-to-night variability of physiological measurements taken during sleep. METHODS: One hundred and sixty-six children, aged 3.2-4.0 years, identified as at high (n = 83, M/F = 1.5:1) or low (n = 83, M/F = 1.4:1) risk for persistent snoring, as rated by a parent, wore a sleep screening system (Grey Flash) for up to five consecutive nights, to measure snoring, oxygen saturation, heart rate, movement, sleep efficiency, and sleep timing. RESULTS: The snoring group snored 25% of their total sleep time, while the non-snoring group snored just 7.6%. Reliability estimates were calculated, using intraclass correlations to establish the reliability of single recordings and the Spearman-Brown prophecy formula to estimate reliability over multiple recordings. Snoring (percent), turn index (number of turns per hour), and mean heart rate were adequately assessed in both groups with one recording night (all intraclass correlation coefficients (ICCs) ≥0.70). Furthermore, mean SpO(2) was measured with sufficient reliability with two recordings in non-snorers (ICC = 0.71), while five recording nights were necessary to reach reliability in snorers (ICC = 0.71). SpO(2) nadir did not reach adequate reliability in either group even after seven recording nights. CONCLUSIONS: Our results showed that snoring can be measured reliably at home with just one recording night, whereas most other physiological sleep measures require two or more recordings.

Prevalence and factors associated with snoring in 3-year olds: early links with behavioral adjustment.

OBJECTIVE: Identify the prevalence of sleep disordered breathing (SDB) symptoms in a community sample of New Zealand 3-year olds. To examine sleep, demographic, health, environmental, familial, perinatal, and behavioral adjustment factors associated with habitual snoring. METHODS: A cross sectional study, in which parents of 823 children aged 3 years 0 months to 3 years 12 months (M:F=1:0.9) were recruited from the community. Participants completed questionnaires designed to assess information relevant to their children's sleep, with a particular focus on snoring. RESULTS: Parents reported snoring at least once a week in 36.9% of children, and habitual snoring (more than four nights per week) in 11.3% of children. Univariate analysis showed habitual snoring was more common amongst Maori (indigenous New Zealanders) (P=0.04) and males (P=0.05), and that habitual snorers came from more socio-economically deprived neighborhoods (P<0.01). Several other SDB-related symptoms were significantly associated with habitual snoring: mouth breathing, sweating profusely, waking during the night, sleeping with neck extended, constant runny nose, and suffering from tonsillitis. Mouth breathing was the most strongly associated. Multivariate analyzes revealed a strong positive relationship between snoring and some health and familial factors, as well as parent reported child irritability (OR=2.83; 95% CI 1.4-5.6) and hyperactivity (OR=1.6; 95% CI 1.0-2.7). CONCLUSIONS: The prevalence of habitual snoring amongst New Zealand pre-schoolers is similar to that reported elsewhere. Factors associated with habitual snoring include male gender, Maori ethnicity, and poorer deprivation neighborhood, as well as a variety of other environmental and health factors. The data provide evidence that habitual snoring associated with irritable and hyperactive behavior is evident in children as young as three.

Parent and teacher rating scales in the evaluation of attention-deficit hyperactivity disorder: contribution to diagnosis and differential diagnosis in clinically referred children.

This study evaluated diagnostic utility of parent and teacher ratings in the attention-deficit hyperactivity disorder (ADHD) assessment and differential diagnosis of a clinical sample of children referred for suspected ADHD. Participants were 184 5- to 12-year-old children for whom the following were available: multimethod multi-informant assessment, firm decision regarding presence or absence of ADHD, and parent-completed Child Behavior Checklist and revised 48-item Conners Parent Rating Scale, and teacher-completed Teacher Report Form and 39-item Conners Teacher Rating Scale. Parent ratings of children diagnosed with and without ADHD were generally similar. In contrast, teachers rated students diagnosed with ADHD as displaying higher levels of behavioral difficulties. Discriminant function analyses indicated parent ratings of narrowband measures of ADHD and broadband measures of externalizing symptoms displayed high sensitivity. Teacher ratings outperformed parent ratings when considering sensitivity, specificity, and overall classification accuracy. For clinically recommended cut scores, teacher measures displayed good specificity and positive predictive power. Combining rating scales within informants. did not improve classification accuracy. Combining across parent and teacher measures produced results consistent with teacher ratings. Results support recommendations to include parent and teacher rating scales in ADHD assessment. Scales contributing most to classification accuracy were those designed to assess ADHD. Imperfect performance of rating scales supports recommendations to include other methodologies in diagnosis and differential diagnosis of ADHD.