title: Pre-school development and behavior screening with a consecutive support programs for 5-year-olds reduces the rate of school refusal.
abstract: OBJECTIVE
  The efficacy of pre-school health consultation in improving developmental and behavioral problems at 5-years of age with follow-up consecutive educational support before and after entrance into regular elementary school for 8 years in a rural city, Taketa, Oita prefecture, was evaluated.
  
  
  METHODS
  This program involved a survey with a three-step method as follows. Step 1: interviews and checklists conducted by public health nurses and nursery/kindergarten teachers for all children. Step 2: medical screening for all children performed by a local/home-school doctor. Step 3: diagnosis in selected children carried out by child neurologists, special support education teachers and clinical/school psychologists. Subsequently, for 1-2 years until entrance into elementary school, these children and their parents were given speech, behavioral and mental support as well as group play therapy in nursery/kindergarten.
  
  
  RESULTS
  During the 8-years study period, 56 children (5.4%) were diagnosed with developmental disorders and six children were diagnosed with maltreatment by their parents among 1165 eligible children. Of these subjects, 40 children received support consecutively after entrance into school, 38 of whom entered regular elementary school and 32 attended regular classes for 1-6 years. A total of 39 of 40 children have attended school without refusal. Moreover, the total number of students refusing to attend school in elementary school decreased for 3 years from 8 of 3246 children (0.25%) in 2006-2008 and 13 of 2889 children (0.45%) in 2009-2011 to only 1 of 2646 children (0.04%) in 2012-2014.
  
  
  CONCLUSIONS
  Pre-school developmental-behavioral screening and consecutive support programs in a rural city reduced the number of students refusing to attend school.
authors.affiliation: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan. Electronic address: kseigo@oita-u.ac.jp.
authors.forename: Seigo
authors.initials: S
authors.lastname: Korematsu
authors.affiliation: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takano
authors.affiliation: Department of Pediatrics and Child Neurology, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Izumi
mesh_terms: D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000517:prevention & control*; D018479:Early Intervention, Educational; D004522:Educational Status; D006801:Humans; D007564:Japan; D012424:Rural Population; D012574:Schools; D013334:Students; D011795:Surveys and Questionnaires
keywords: 5-Year-old; Developmental disorders; Pre-school health consultation; School refusal