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Background: Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child's life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children's reading at 8-9 years., Methods: Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children's reading at 8-9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage., Results: A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=-14.03, 95% CI=-16.61 to -11.44). Effects were similar for disadvantaged and non-disadvantaged children., Conclusion: This study supports the potential value of 'stacking' early interventions across the early years of a child's life to maximise impacts on child outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Understanding the relationship between different aspects of disadvantage over time and domains of child development will facilitate the formulation of more precise policy responses. We examined the association between exposure to aspects of disadvantage over the childhood period (from 0-9 years) and child development at 10-11 years., Methods: We used data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (n = 4979). Generalized linear models with log-Poisson link were used to estimate the association between previously derived disadvantage trajectories (in each of four lenses of sociodemographic, geographic environments, health conditions and risk factors, and a composite of these) and risk of poor child developmental outcomes. Population-attributable fractions were calculated to quantify the potential benefit of providing all children with optimal conditions for each developmental outcome., Results: Trajectories of disadvantage were associated with developmental outcomes: children in the most disadvantaged composite trajectory had seven times higher risk of poor outcomes on two or more developmental domains, compared with those most advantaged. Trajectories of disadvantage in different lenses were varyingly associated with the child development domains of socio-emotional adjustment, physical functioning and learning competencies. Exposure to the most advantaged trajectory across all lenses could reduce poor developmental outcomes by as much as 70%., Conclusions: Exposure to disadvantage over time is associated with adverse child development outcomes. Developmental outcomes varied with the aspects of disadvantage experienced, highlighting potential targets for more precise policy responses. The findings provide evidence to stimulate advocacy and action to reduce child inequities.

Background: Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child's development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development., Methods: Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10-11 years., Results: We found four distinct trajectories of children's exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the 'most disadvantaged' trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity., Conclusions: Children's overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.

Background: Child health and developmental inequities exist in all countries. Comprehensive and robust concepts of disadvantage are fundamental to growing an evidence base that can reveal the extent of inequities in childhood, and identify modifiable leverage points for change. We conceptualise and test a multidimensional framework of child disadvantage aligned to a social determinants and bioecological perspective., Methods: The Longitudinal Study of Australian Children is a nationally representative sample of two cohorts of Australian children, including the birth cohort of 5107 infants, which commenced in May 2004. The analysis focused on disadvantage indicators collected at age 4-5 years. Confirmatory factor analysis was used to test a theoretically informed model of disadvantage. Concurrent validity was examined through associations with academic performance at 8-9 years., Results: The model comprising four latent factors of sociodemographic (10 indicators), geographical environments (three indicators), health conditions (three indicators) and risk factors (14 indicators) was found to provide a better fit for the data than alternative models. Each factor was associated with academic performance, providing evidence of concurrent validity., Conclusion: The study provides a theoretically informed and empirically tested framework for operationalising relative child disadvantage. Understanding and addressing inequities will be facilitated by capturing the complexity of children's experiences of disadvantage across the multiple environments in which their development unfolds., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Until now, child mental health promotion efforts have focused primarily on reducing the prevalence and severity of problems; yet the absence of mental health problems does not necessarily imply the presence of healthy psychosocial functioning. We aimed to investigate the epidemiology of child mental health competence in a full national population of school entrants., Methods: The data source was the 2012 Australian Early Development Index, a national census of early childhood development completed for school entrants by teachers across Australia (n=275 800). The mental health competence outcome measure was derived from constructs that focused on children's social and emotional strengths. Children with mental health competence scores in the top quintile were compared with the standard population across individual and community characteristics., Results: Average age at assessment was 5 years 7 months. Higher odds of mental health competence were observed for children who lived in more advantaged areas (OR 1.62; 99% CI 1.49 to 1.75), had attended preschool (1.38; 1.25 to 1.51) and demonstrated effective oral communication skills in the classroom (19.01; 15.62 to 23.13). Indigenous children had lower odds compared with non-Indigenous children (0.59; 0.54 to 0.64). Children in disadvantaged areas who attended preschool did not 'catch up' with their more advantaged peers., Conclusions: Mental health competence is unequally distributed across the Australian child population at school entry and is strongly predicted by measures and correlates of disadvantage. Effective oral communication and attendance at preschool warrant further investigation as potentially modifiable factors that may support mental health competence in new school entrants., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development. The relatively few studies exploring this relationship support associations between child development and neighborhood destinations, green spaces, interaction with nature, traffic exposure, and housing density. These studies emphasize the need to more deeply understand how child development outcomes might be influenced by the neighborhood built environment. Pursuing this research space is well aligned with the current global movements on livable and child-friendly cities. It has direct public policy impact by informing planning policies across a range of sectors (urban design and planning, transport, public health, and pediatrics) to implement place-based interventions and initiatives that target children's health and development at the community level. We argue for the importance of exploring the effect of the neighborhood built environment on child development as a crucial first step toward informing urban design principles to help reduce developmental vulnerability in children and to set optimal child development trajectories early., (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)

Objective: Children with special health care needs are an important population for educational and health service providers. Accurate information about the prevalence and characteristics of these children and their families is needed to inform the planning and development of systems of care, yet data in Australia are currently lacking., Methods: This study utilizes population-level data from the Australian Early Development Index, a teacher-rated checklist, to provide estimates of the prevalence and developmental and demographic characteristics of Australian children with special health care needs on entrance to school., Results: Four percent of children were reported with established special health care needs, and a further 18% were identified by teachers as "of concern." These children showed higher rates of vulnerability across all domains of development. Although children with established special health care needs were represented across demographic profiles, proportions were greater among boys, those from lower socioeconomic status communities, and Indigenous and older children. In contrast, those living in more remote settings were as likely to be identified as "of concern" as their peers but were less likely to have established special health care needs., Conclusions: These findings have important implications for service provision and policy development. There are substantial opportunities to reorient schooling and early childhood systems to better detect and accommodate the needs of these children.

There is increasing acknowledgement of the importance of the early years of school in laying the foundations for children's learning pathways, and interest in the role of mental health in promoting positive early learning experiences. Understanding child mental health requires consideration of both mental health competence and mental health difficulties. The aim of this paper was to determine how profiles of competence and difficulties relate to children's early learning skills in their first year of school. Cross-sectional data from a population census was used to explore whether children's mental health profile (the combination of competence and difficulties) predicted key domains of early learning. In 2015, the Australian Early Development Census (a teacher-rated measure of child development) was completed for 96.5% of Australian children in their first year of schooling (N = 302,003; M = 5 years, 7 months of age). Logistic regression analyses revealed that mental health profiles were strongly related to two key domains of early learning: language and cognitive skills, and communication skills and general knowledge. Anything less than the optimal high competence with low difficulties profile was associated with substantially poorer early learning skills (OR 2.17, p < 0.001 to OR 67.75, p < 0.001). These results suggest that profiles of mental health competence and difficulties are a salient factor as children begin school, and illustrate the importance of recognising both competence and difficulties when considering the mental health of young children.

Children who enter school with limited proficiency in the language of instruction face a range of challenges in negotiating this new context, yet limited data have been available to describe the early developmental outcomes of this subpopulation in the Australian context. The Australian Early Development Index (AEDI) is a teacher-rated checklist that measures five important domains of child development: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. In 2009, the AEDI was completed for 97.5% of Australian children in their first year of schooling ("N" = 261,147; "M" = 5 years, 7 months of age), providing a unique opportunity to explore the cross-sectional associations between language background, proficiency in English, and early developmental outcomes at the population-level. Logistic regression analyses revealed that, compared to their peers from English-speaking backgrounds, bilingual children who were not yet proficient in English had substantially higher odds of being in the "vulnerable" range (bottom 10th percentile) on the AEDI domains ("OR" = 2.88, "p" < 0.001, to "OR" = 7.49, p < 0.001), whereas English-proficient bilingual children had equal or slightly lower odds ("OR" = 0.84, "p" < 0.001, to "OR" = 0.97, "ns"). Future research with longitudinal data is now needed to establish causal pathways and explore long term outcomes.

This article responds to recent calls for a focus on successful development in young people and examination of its developmental precursors, in order to identify potentially modifiable targets for interventions. The current study examined child and adolescent precursors of positive functioning in emerging adulthood, including individual characteristics, relationship factors, and connections to the community, using a multidimensional positive development measure at 19-20 years. The sample consisted of 511 males and 647 females who were participants in the Australian Temperament Project, a population based longitudinal study that has followed young people's psychosocial adjustment from infancy to early adulthood. Higher levels of positive development in emerging adulthood were associated with stronger family and peer relationships, better adjustment to the school setting, higher family socioeconomic status, and better emotional control. Some significant gender differences were observed, with emotional control, family relationships, and community orientation all being stronger predictors of males' than of females' positive development. The findings provide possible targets for child and adolescent interventions to promote positive development in early adulthood.

The transition to adulthood is characterised by both great potential for positive change and a relatively high incidence of problem outcomes. A multidimensional model of positive development during the transition to adulthood (at 19-20 years) has recently been proposed. However, an unresolved question regarding the nature of positive development during this time is how best to conceptualise its relationship to psychopathology. We drew on data from 1158 participants in the Australian Temperament Project, a large longitudinal community-based study that has followed young people's psychosocial adjustment from infancy to early adulthood. Using structural equation modelling, we compared three models reflecting different conceptualisations of the relationship between positive development and psychopathology. The results suggest that positive development and psychopathology are best modelled as separate but correlated constructs. Hence, development in one domain is likely to influence the other, although separate and specific developmental pathways are also likely to be operating.

This study examined whether positive development (PD) in adolescence and young adulthood predicts offspring behavior in two Australasian intergenerational cohorts. The Australian Temperament Project Generation 3 Study assessed PD at age 19–28 (years 2002–2010) and behavior in 1165 infants (12–18 months; 608 girls) of 694 Australian‐born parents (age 29–35; 2012–2019; 399 mothers). The Dunedin Multidisciplinary Health and Development Parenting Study assessed PD at age 15–18 (years 1987–1991) and behavior in 695 preschoolers (3–5 years; 349 girls) and their New Zealand born parents (age 21–46; 1994–2018; 363 mothers; 89% European ethnicity). In both cohorts, PD before parenthood predicted more positive offspring behavior (βrange =.11–.16) and fewer behavior problems (βrange = −.09 to −.11). Promoting strengths may secure a healthy start to life. [ABSTRACT FROM AUTHOR]

Exposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10–11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity. Adversity was assessed every 2 years from 0–1 to 10–11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4 to 5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences). By 10–11 years, 52.8% (95% confidence interval [CI] 51.0–54.7) of children had been exposed to 2 or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had 4 to 8 times the odds of exposure to 2 or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (odds ratio [OR] 4.3, 95% CI 2.8–6.6 and OR 8.1, 95% CI 4.4–14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4–2.3 and OR 2.3, 95% CI 1.3–4.3, respectively). Addressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children. [ABSTRACT FROM AUTHOR]

Objectives: Children's additional health and developmental needs are often first identified by teachers when they begin school. This study estimates the Grade 3 literacy and numeracy outcomes of children with teacher‐identified additional needs emerging in the first year of school, including the added burden conferred by socioeconomic disadvantage. Methods: Population linked data (n = 42,619) were analysed from the Australian Early Development Census, which include teacher reports on children's health and development at school entry, and the National Assessment Program–Literacy and Numeracy, a direct assessment of reading and numeracy skills at Grade 3. Linear regression analyses were used to estimate associations between emerging needs and learning outcomes, adjusted for sociodemographic characteristics. The combined effect of emerging needs and low maternal education (an indicator of socioeconomic disadvantage) on academic outcomes was examined by estimating the relative excess risk due to interaction (RERI). Results: Emerging health and developmental needs at school entry were associated with lower reading (b = −26.86, 95% CI = −29.19, −24.52) and numeracy (b = −24.39, 95% CI = −26.43, −22.35) outcomes at Grade 3. The combined effect of emerging needs and socioeconomic disadvantage was greater than expected when their individual effects are summed (RERI = 0.38, 95% CI 0.22, 0.55 for reading and RERI = 0.27, 95% CI 0.10, 0.43 for numeracy). Conclusion: In the current study, emerging health and developmental needs identified by teachers at the outset of schooling were associated with poorer literacy and numeracy skills at Grade 3, and family socioeconomic disadvantage appeared to further amplify this effect. Meeting the needs of these children will require timely and coordinated supports across the health and education systems, particularly for those children who are also disadvantaged. [ABSTRACT FROM AUTHOR]

Aim: A fifth of children enter school with special health care needs (SHCN) impacting on their physical, psychosocial or educational development, including many with emerging SHCN who often do not qualify for additional supports. This study aimed to compare the perceptions of parents and teachers on children's emerging SHCN, and explore correlates of conflicting reports.Methods: The Longitudinal Study of Australian Children (LSAC) is a nationally representative study of Australian children, which includes the abbreviated Children with Special Health Care Needs Screener. Data were analysed from a subsample of n = 720 children from the LSAC Kindergarten cohort (n = 4983) for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development that includes teacher reported SHCN.Results: Teachers (n = 120, 17.34%) identified more emerging SHCN than parents (n = 74, 10.74%), and reports were often discrepant. Children were more likely to have consistent reports of emerging SHCN when their parents had high levels of involvement at school (OR 4.86; 95% CI 1.08-21.80; P < 0.05), whereas children who came from disadvantaged family backgrounds were more likely to have teacher-only identified difficulties (OR 3.66; 95% CI 1.17-11.50; P < 0.05).Conclusion: Parents and teachers bring different perspectives to children's development and additional support needs, each of which is valuable. Greater attention should be given to ensuring that common understandings about a child's needs at school are established early in children's educational pathways. [ABSTRACT FROM AUTHOR]

Growing concern about the global burden of child mental health disorders has generated an increased interest in population-level efforts to improve child mental health. This in turn has led to a shift in emphasis away from treatment of established disorders and towards prevention and promotion. Prevention efforts are able to draw on a substantial epidemiological literature describing the prevalence and determinants of child mental health disorders. However, there is a striking lack of clearly conceptualised and measurable positive outcomes for child mental health, which may result in missed opportunities to identify optimal policy and intervention strategies. In this paper, we propose an epidemiological approach to child mental health which is in keeping with public health principles and with the WHO definition of health, and which is grounded in current thinking about child development. Constructs such as competence offer the opportunity to develop rigorous outcome measures for epidemiological research, while broader ideas about ‘the good life’ and ‘the good society’ derived from philosophical thinking can enable us to shape policy initiatives based on normative ideas of optimal child mental health that extend beyond individuals and undoubtedly beyond the traditional boundaries of the health sector. [ABSTRACT FROM AUTHOR]

Children who enter school with limited proficiency in the language of instruction face a range of challenges in negotiating this new context, yet limited data have been available to describe the early developmental outcomes of this subpopulation in the Australian context. The Australian Early Development Index (AEDI) is a teacher-rated checklist that measures five important domains of child development: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. In 2009, the AEDI was completed for 97.5% of Australian children in their first year of schooling (N = 261,147; M = 5 years, 7 months of age), providing a unique opportunity to explore the cross-sectional associations between language background, proficiency in English, and early developmental outcomes at the population-level. Logistic regression analyses revealed that, compared to their peers from English-speaking backgrounds, bilingual children who were not yet proficient in English had substantially higher odds of being in the “vulnerable” range (bottom 10th percentile) on the AEDI domains (OR = 2.88, p < .001, to OR = 7.49, p < .001), whereas English-proficient bilingual children had equal or slightly lower odds (OR = .84, p < .001, to OR = .97, ns). Future research with longitudinal data is now needed to establish causal pathways and explore long term outcomes. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that engagement with quality early childhood education and care (ECEC) programs such as preschool can enhance children’s early development. The Australian Early Development Census (AEDC) provides a unique opportunity to explore the relationship between ECEC and children’s developmental outcomes in a full population cohort of Australian school entrants. The AEDC is a teacher-rated checklist that provides data on ECEC experiences in the year before starting school, as well as five important domains of child development at school entry: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. In 2009, the AEDC was completed for 97.5% of Australian children in their first year of formal schooling ( N = 261,147; M = 5 years, 7 months of age). Logistic regression analyses revealed that attendance at preschool was associated with reduced odds (OR = 0.69, p < 0.001 to OR = 0.40, p < 0.001) of being in the vulnerable range (<10th percentile) on four of the five AEDC domains (with the exception of emotional maturity; OR = 0.89, p = 0.002), compared to other ECEC experiences, or care exclusively by parents. Subsequent analyses revealed that this effect was evident for children living in both advantaged and disadvantaged communities. Together, the results suggest that engagement with preschool programs in Australia may present a plausible, equitable, and modifiable approach to improving children's developmental outcomes. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between geographic availability (and quality) of local early childhood education and care services and children's early mental health outcomes for all children entering their first year of full-time school in Melbourne, Australia. We capitalise on a unique population linked dataset, the Australian Early Development Census – Built Environment, which combines geospatial measures of children's neighbourhoods with demographic information and child mental health outcomes for all school entrants in Australia's 21 most populous cities and towns. Objective early childhood education and care service location and quality exposures were developed for each study child based on home addresses. Four geographic availability exposures (counts within 3 km) were examined for cross-sectional associations with child mental health outcomes (externalising and internalising difficulties, competence). We estimated associations using multilevel logistic regression (Markov Chain Monte Carlo estimation) adjusting for child demographics and stratifying by urbanicity. Children with higher counts of high-quality preschool services within 3 km of home had lower odds of difficulties and higher odds of competence. Overall, exposures were most consistently associated with children's competence. Across all outcomes, the most consistent patterning was observed for children living in the inner city and middle ring. Results varied depending on whether service quality was accounted for in measures of availability. Geographic availability of early childhood services showed patterning by neighbourhood disadvantage and by maternal education. We found some evidence that geographic availability of high-quality preschools was associated with better child mental health outcomes, but results varied by urbanicity. While future research is required to unpack these differences, these findings indicate the importance of accounting for both geographic availability and service quality simultaneously in future research, policy and practice. • High-quality early childhood services are critical for good early child development. • It is not known how availability of these services relates to child mental health. • We analysed linked geospatial and health data for all school entrants in Melbourne. • Greater availability of high-quality preschools was linked to better mental health. • Disadvantaged children had poorer access to high-quality services than their peers. [ABSTRACT FROM AUTHOR]

Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health. Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0–1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4–5 years, and an intermediate outcome, parental mental health (poor versus good) at 2–3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0–1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated. A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864). Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities. • Income supplements provided to lower-income households may improve children's development. • Household income supplements may also be beneficial to parental mental health. • The absolute reduction in risk of poor outcomes ranged between 0.8% and 2.8%. • Household income supplements alone are insufficient to eliminate child inequities. • Stacking multiple complementary interventions over the life course is needed. [ABSTRACT FROM AUTHOR]