title: Associations between preschool attendance and developmental impairments in pre-school children in a six-year retrospective survey.
abstract: BACKGROUND
  Many school-aged children suffer physical and mental impairments which can adversely affect their development and result in significant morbidity. A high proportion of children in western countries attend pre-school, and it is likely that the preschool environment influences the prevalence and severity of these impairments. Currently there is insufficient data available on the prevalence of these impairments and their causal associations. The influence that location of a pre-school and the duration of preschool attendance have on the prevalence of these impairments is not known.
  
  
  METHODS
  In a retrospective survey spanning six years (1997-2002) we reviewed the records of 6,230 preschool children who had undergone routine school entry assessments. These children had been assessed utilising a modified manual of the "Bavarian Model" for school entry examinations. This model outlines specific criteria for impairments of motor, cognitive, behavioural and psychosocial functioning. Prevalence rates for physical and behavioural impairments were based on the results of these assessments. The relationship between the prevalence of impairments and the duration of preschool attendance and the location of the preschool attended was estimated utilizing logistic regression models.
  
  
  RESULTS
  We found that 20.7% of children met the criteria for at least one type of impairment. Highest prevalence rates (11.5%) were seen for speech impairments and lowest (3.5%) for arithmetic impairments. Boys were disproportionately over represented, with 25.5% meeting the criteria for impairment, compared to 13.0% for girls. Children who had attended preschool for less than one year demonstrated higher rates of impairment (up to 19.1% for difficulties with memory, concentration or perseverance) compared to those who had attended for a longer duration (up to 11.6% for difficulties with pronunciation). Children attending preschool in an urban location had slightly elevated rates of impairment (up to 12.7%), compared to their rural counterparts (up to 11.1%).
  
  
  CONCLUSIONS
  Our results demonstrate that there are high prevalence rates for physical and mental impairments among preschool children. Furthermore, children without preschool experience are a risk group for struggling with educational successes. The associations between the duration of preschool attendance and location of preschool attended and rates of impairment need replication and further exploration. Larger prospective studies are needed to examine if these relationships are causal and may therefore lend themselves to specific intervention strategies.
authors.affiliation: Department of Public Health, District of Dingolfing-Landau, Obere Stadt 1, 84130 Dingolfing, Germany. heribert.stich@web.de
authors.forename: Heribert L
authors.initials: HL
authors.lastname: Stich
authors.forename: Bernhard T
authors.initials: BT
authors.lastname: Baune
authors.forename: Riccardo N
authors.initials: RN
authors.lastname: Caniato
authors.forename: Alexander
authors.initials: A
authors.lastname: Krämer
mesh_terms: D017677:Age Distribution; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000145:classification / Q000453:epidemiology*; D005260:Female; D005843:Geography; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D010808:Physical Examination / Q000706:statistics & numerical data; D015995:Prevalence; D011610:Psychosocial Deprivation; D012189:Retrospective Studies; D018570:Risk Assessment; D012423:Rural Health / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D014504:Urban Health / Q000706:statistics & numerical data