Preschool screening for developmental difficulties is increasingly becoming part of routine health service provision and yet the scope and validity of tools used within these screening assessments is variable. The aim of this review is to report on the predictive validity of preschool screening tools for language and behaviour difficulties used in a community setting. Studies reporting the predictive validity of language or behaviour screening tools in the preschool years were identified through literature searches of Ovid Medline, Embase, EBSCO CINAHL, PsycInfo and ERIC. We selected peer-reviewed journal articles reporting the use of a screening tool for language or behaviour in a population-based sample of children aged 2–6 years of age, including a validated comparison diagnostic assessment and follow-up assessment for calculation of predictive validity. A total of eleven eligible studies was identified. Six studies reported language screening tools, two reported behaviour screening tools and three reported combined language & behaviour screening tools. The Language Development Survey (LDS) administered at age 2 years achieved the best predictive validity performance of the language screening tools (sens 67%, spec 94%, NPV 88% and PPV 80%). The Strengths and Difficulties Questionnaire (SDQ) administered at age 4 years achieved the best predictive validity compared to other behaviour screening tools (Sens 31%, spec 93%, NPV 84% and PPV 52%). The SDQ and Sure Start Language Measure (SSLM) administered at 2.5 years achieved the best predictive validity of the combined language & behaviour assessments (sens 87%, spec 64%, NPV 97% and PPV 31). Predictive validity data and diagnostic odds ratios identified language screening tools as more effective and achieving higher sensitivity and positive predictive value than either behaviour or combined screening tools. Screening tools with combined behaviour and language assessments were more specific and achieved higher negative predictive value than individual language or behaviour screening tools. Parent-report screening tools for language achieved higher sensitivity, specificity and negative predictive value than direct child assessment. Universal screening tools for language and behaviour concerns in preschool aged children used in a community setting can demonstrate excellent predictive validity, particularly when they utilise a parent-report assessment. Incorporating these tools into routine child health surveillance could improve the rate of early identification of language and behavioural difficulties, enabling more informed referrals to specialist services and facilitating access to early intervention.

Background and objectives Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine the prevalence of ACEs at age 8 in a recent prospective birth cohort and examine associations between risk factors in the first year and cumulative ACEs. Design This study uses the Growing Up in Scotland Birth Cohort 1, in which children born in Scotland in 2004/5 were identified using Child Benefit Records and followed up for 7 years (n.3119). ACE scores and sample characteristics were calculated and described. Logistic regression models were fitted to explore associations between risk factors (sex, mother’s age and education, household income, area level deprivation and urban/rural indicator) and ACE scores. Results Seven ACEs (or proxies) were assessed: physical abuse, domestic violence, substance abuse, mental illness, parental separation, parental incarceration and emotional neglect. Instances of sexual abuse were too few to be reported. Emotional abuse and physical neglect could not be gathered. Around two-thirds of children had experienced one or more ACE, with 10% experiencing three or more in their lifetime. Higher ACE scores were associated with being male, having a young mother, low income and urban areas. Conclusions Using prospective data, the majority of children born in 2004/2005 in Scotland experienced at least one ACE by age 8, although three ACEs could not be assessed in this cohort. ACEs were highly correlated with socioeconomic disadvantage in the first year of life.

The Triple P parenting programme has been reported to improve child mental health at population level, but it consumes substantial resources. Previous published work has suggested improvements in whole population scores in the Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Scale among samples of children following introduction of the programme. This paper aims to explore whether Triple P had an impact on child mental health problems using routinely collected data over 6 years before and during the implementation of the multilevel Triple P programme in Glasgow City. Annual monitoring of teacher-rated SDQ Total Difficulties Scale scores among children in their pre-school year in Glasgow City. No significant or consistent changes in SDQ Total Difficulties Scale scores were seen during or after the implementation of Triple P programme on a whole population level. Triple P in Glasgow City appears to have had no impact on early child mental health problems over a 6 year period. The Triple P programme, implemented on a whole population level, is unlikely to produce measurable benefits in terms of child mental health.

Background: Developmental delay affects substantial proportions of children. It can generally be identified in the pre-school years and can impact on children’s educational outcomes, which in turn may affect outcomes across the life span. High income countries increasingly assess children for developmental delay in the early years, as part of universal child health programmes, however there is little evidence as to which measures best predict later educational outcomes. This systematic review aims to assess results from the current literature on which measures hold the best predictive value, in order to inform the developmental surveillance aspects of universal child health programmes. Methods: Systematic review sources: Medline (2000 –current), Embase (2000 –current), PsycInfo (2000 –current) and ERIC (2000 –current). Additional searching of birth cohort studies was undertaken and experts consulted. Eligibility criteria: Included studies were in English from peer reviewed papers or books looking at developmental assessment of preschool children as part of universal child health surveillance programmes or birth cohort studies, with linked results of later educational success/difficulties. The study populations were limited to general populations of children aged 0–5 years in high income countries. Study selection, data extraction and risk of bias assessment were carried out by two independent authors and any disagreement discussed. PROSPERO registration number CRD42018103111. Results: Thirteen studies were identified for inclusion in the review. The studies were highly heterogeneous: age of children at first assessment ranged from 1–5 years, and at follow-up from 4–26 years. Type of initial and follow-up assessment also varied. Results indicated that, with the exception of one study, the most highly predictive initial assessments comprised combined measures of children’s developmental progress, such as a screening tool alongside teacher ratings and developmental histories. Other stand-alone measures also performed adequately, the best of these being the Ages and Stages Questionnaire (ASQ). Latency between measures, age of child at initial measurement, size of studies and quality of studies all impacted on the strength of results. Conclusions: This review was the first to systematically assess the predictive value of preschool developmental assessment at a population level on later educational outcomes. Results demonstrated consistent associations between relatively poor early child development and later educational difficulties. In general, specificity and Negative Predictive Value are high, suggesting that young children who perform well in developmental assessment are unlikely to go on to develop educational difficulties, however the sensitivity and Positive Predictive Values were generally low, indicating that these assessments would not meet the requirements for a screening test. For surveillance purposes, however, findings suggested that combined measures provided the best results, although these are resource intensive and thus difficult to implement in universal child health programmes. Health service providers may therefore wish to consider using stand-alone measures, which also were shown to provide adequate predictive value, such as the ASQ.

Objective To examine the association between high maternal weight status and complications during pregnancy and delivery. Setting Scotland. Participants Data from 132 899 first-time singleton deliveries in Scotland between 2008 and 2015 were used. Women with overweight and obesity were compared with women with normal weight. Associations between maternal body mass index and complications during pregnancy and delivery were evaluated. Outcome measures Gestational diabetes, gestational hypertension, pre-eclampsia, placenta praevia, placental abruption, induction of labour, elective and emergency caesarean sections, pre-term delivery, post-term delivery, low Apgar score, small for gestational age and large for gestational age. Results In the multivariable models controlling for potential confounders, we found that, compared with women with normal weight, the odds of the following outcomes were significantly increased for women with overweight and obesity (overweight adjusted ORs; 95% CI, followed by the same for women with obesity): gestational hypertension (1.61; 1.49 to 1.74), (2.48; 2.30 to 2.68); gestational diabetes (2.14; 1.86 to 2.46), (8.25; 7.33 to 9.30); pre-eclampsia (1.46; 1.32 to 1.63) (2.07; 1.87 to 2.29); labour induction (1.28; 1.23 to 1.33), (1.69; 1.62 to 1.76) and emergency caesarean section (1.82; 1.74 to 1.91), (3.14; 3.00 to 3.29). Conclusions Women with overweight and obesity in Scotland are at greater odds of adverse pregnancy and delivery outcomes. The odds of these conditions increases with increasing body mass index. Health professionals should be empowered and trained to deliver promising dietary and lifestyle interventions to women at risk of overweight and obesity prior to conception, and control excessive weight gain in pregnancy.

Background This paper examines socioeconomic inequalities in mental health at school entry and explores changes in these inequalities over the first 3 years of school. Methods The study utilises routinely collected mental health data from education records and demographic data at ages 4 and 7 years, along with administrative school-level data. The study was set in preschool establishments and schools in Glasgow City, Scotland. Data were available on 4011 children (59.4%)at age 4 years, and 3166 of these children were followed at age 7 years (46.9% of the population). The main outcome measure was the teacher-rated Goodman’s Strengths and Difficulties Questionnaire (4–16 version) at age 7 years, which measures social, emotional and behavioural difficulties. Results Children living in the most deprived area had higher levels of mental health difficulties at age 4 years, compared with their most affluent counterparts (7.3%vs4.1% with abnormal range scores). There was a more than threefold widening of this disparity over time, so that by the age of 7 years, children from the most deprived area quintile had rates of difficulties 3.5 times higher than their more affluent peers. Children’s demographic backgrounds strongly predicted their age 7 scores, although schools appeared to make a significant contribution to mental health trajectories. Conclusions Additional support to help children from disadvantaged backgrounds at preschool and in early primary school may help narrow inequalities. Children from disadvantaged backgrounds started school with a higher prevalence of mental health difficulties, compared with their more advantaged peers, and this disparity widened markedly over the first 3 years of school.