Background: One in every nine school-age children in Ontario has special needs (SN) as a result of developmental disorders, however, the distribution of SN is unequal among schools. This prompted a group level exploration of the developmental health outcomes of typically developing children in schools with SN children. Methods: This study uses data from the Early Development Instrument (EDI; kindergarten measure of child development), administered in Ontario between 2010-2012, and neighbourhood-level socioeconomic status (SES) from the 2006 Canadian Census to examine associations between school SN prevalence and typically developing children’s development. Relationships between school SN prevalence and developmental health in those schools were explored in Grade 3 using Education, Quality and Accountability Office (EQAO) tests. Findings: Kindergarten multivariable regression model showed that school SN prevalence was associated with school level kindergarten vulnerability rates after controlling for SES and demographic factors. However, school SN prevalence was not a significant predictor of school performance in Grade 3 reading, writing and math test scores. Our exploration revealed that school kindergarten vulnerability rate, which was itself associated with the school prevalence of children with SN, was a stronger predictor of school Grade 3 academic outcomes than school SN prevalence after controlling for demographic and SES factors. Conclusions: This study provides a snapshot of population level inequalities in child health outcomes by demonstrating associations between school SN prevalence and kindergarten vulnerability, and kindergarten vulnerability and Grade 3 achievement. These findings further emphasize the importance of adequate early intervention programs in schools, and appropriate resource allocation for the health outcomes of typically developing children. / Thesis / Master of Health Sciences (MSc)

Title: Maternal Mood and Anxiety Disorders and Child School Readiness: A Manitoba Population-Based Study Objective: This study examined the relationship between several features of maternal Mood/Anxiety – timing, recurrence/persistence and severity – and child development on five key areas of school readiness at kindergarten, controlling for health, demographic and socio-economic factors. Methods: Using administrative data to further understand these relationships at a population level and over time, 18,331mother-child pairs were linked using a unique identifier. Maternal Mood/Anxiety was defined using the number of physician visits for mood and anxiety disorders and the number of prescriptions filled for antidepressants or sedatives/hypnotics. The outcome measures were child scores on five domains of the Early Development Instrument, a population-level tool for determining readiness for school at an aggregate level. Structural equation modeling was used to examine the relationship between maternal Mood/Anxiety and child outcomes for individual time periods, Mood/Anxiety recurrence/persistence and Mood/Anxiety severity. Infant health at birth, the family/socio-economic environment, child age and child gender were also entered into the models. Stratified analysis was undertaken to determine whether SES moderates the relationship between Mood/Anxiety and child outcomes. Results: Maternal Mood/Anxiety had a modest significant negative association with EDI scores, particularly for social, emotional and physical development. Prenatal and recurrent Mood/Anxiety were associated with lower scores on all five outcome domains. The influence of maternal Mood/Anxiety was mediated by the family environment, which had a strong, significant association with the outcomes, particularly for language and cognitive development. Infant health at birth was significantly associated with child outcomes, particularly for physical health. Socio-economic status (SES) was a moderator of the relationship between Mood/Anxiety and child outcomes. Conclusion: Using administrative data to define maternal mood and anxiety disorders is a sensitive measure to detect differences in five key areas of child development, particularly for social, emotional and physical outcomes. Family-related variables had a much stronger relationship with child outcomes than mood and anxiety disorders. Findings from this study can be used to design, implement and evaluate high quality clinical, program and policy interventions to support mothers and families and the healthy development of their children.

Life course literature states that early childhood development (ECD) can influence most aspects of health throughout the life-cycle. Canada ranked last among 25 wealthy nations in meeting ECD objectives. Fewer than 5% of children born have clinically detectable shortcomings in developmental health, increasing to 26% by school age with emerging socioeconomic associations. Understanding how social determinants of health (SDH) influence ECD at the household and neighbourhood scales would help identify conditions for optimal developmental outcomes. The effects of SDH on ECD in the Kingston, Ontario area were studied. SDH were classified via marginalization (ONMarg) and deprivation (Pampalon) indices. ECD was measured via 2006 Early Development Instrument (EDI) scores for children most at risk upon school entry (Grade One). The basic spatial unit of analysis was 2006 Census of Canada Dissemination Areas, subdivided into quintiles of deprivation (Q1 being the least deprived and Q5 the most). EDI results from each of the quintiles within the two indices were compared and then combined. The socioeconomic health gradient assumes that EDI scores will directly correlate to material and social deprivation. Social deprivation had a slightly greater impact than material deprivation on children’s developmental vulnerability, with Q5 being the most vulnerable in all competencies. Surprisingly, emotional health and social competence were significant areas of vulnerability for children in Q1 and Q2. “Village effects” – when social determinants at the neighbourhood level have protective effects on ECD despite material deprivation at the household level – were present within the Q3 and Q4 groups for the domains of social competency and emotional health. While the highest proportions of early childhood developmental vulnerability are found within the most deprived households, the largest numbers of vulnerable children are spread throughout the middle-class in a variety of neighbourhoods. Canadian policy should focus on mediating avoidable risks within this critical time to avoid future deleterious health effects and costs. Mapping the effects of SDH at the neighbourhood level generates knowledge that informs intersectoral action by policy makers to provide the supports needed to foster healthy children. / Thesis (Master, Geography) -- Queen's University, 2013-05-04 10:36:25.165