Abstract
Objectives
To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs).
Methods
We analyzed national data on children ages 3–5 from 2016–2020 (N = 26,871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on-track for school readiness, defined using a pilot, multidimensional measure called “Healthy and Ready to Learn.” Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure.
Results
Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (adjusted odds ratio [aOR]: 2.19, 95% confidence interval [CI]: 1.86, 2.58) and high (aOR: 4.37, 95% CI: 3.58, 5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration).
Conclusions
Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.
Article Summary
This national study characterizes how positive early childhood experiences correlate with a multidimensional measure of school readiness, while also accounting for adverse childhood experiences.
School readiness – or the cognitive, social, and emotional competencies needed to successfully function in the kindergarten to 12th grade (K-12) school system – is foundational to children’s health and development.1–8 Less than half of 3- to 5-year-old U.S. children are on-track to begin elementary schooling, with even lower rates for low-income and racial/ethnic minority children.1,7,9 School readiness is linked not only to children’s development in multiple areas10–12 but to diverse outcomes across the life course such as high school graduation,13 incarceration,14 and adult cardiometabolic health.15 In light of these compelling data, interventions targeting school readiness have been investigated and shown that children in disadvantaged contexts, in particular, can be more ready for school with investments into early child development.16–18 Collectively, this literature underscores the need to better understand, and ultimately act upon, school readiness gaps to achieve health equity.
To date, scholars have focused on how adverse childhood experiences (ACEs) – such as abuse, neglect, and various forms of household instability – undermine school readiness and related indicators such as social-emotional well-being and executive function.1,4,19–23 This relationship has been borne out in national studies - for instance, Jackson and colleagues4 found that one-half of U.S. children with no ACEs were on track across all school readiness domains, while only one-fifth of children with 3+ ACEs were. Such adversities can amplify the negative effects of child health conditions such as preterm birth and secondhand smoke exposure on school readiness.24,25 Despite these findings, we know little about the role that positive or protective early childhood factors might play in fostering school readiness and how they may buffer the impact of traumatic events.4,12,26
Evidence on positive childhood experiences has shown how safe, stable, nurturing environments (e.g., supportive neighborhoods, parent-child connection) and early learning opportunities foster improved developmental outcomes.3,12,27 These experiences may track with improved school outcomes in a dose-response fashion, even in the presence of developmental stressors such as ACEs.12,26 Studies by Crouch and colleagues suggest that positive childhood experiences like having a mentor can buffer children ages 6–18 against repeating grades and absenteeism.3,27 There is reason to suspect that positive experiences, environments, and relationships encountered in early childhood would enhance school functioning as well, as emphasized in the prevailing “interactional relational” model of school readiness.28,29 Better understanding of how such positive early childhood experiences (PECEs) help children prepare for school would prove valuable, as many at-risk children only receive developmental assessment and supports once in K-12 education.23,30 Optimization of PECEs could complement and extend the reach of existing efforts, such as Early Intervention programs, during a sensitive developmental window.
The present study builds upon extant literature by exploring how PECEs relate to school readiness among preschool-age children, and how PECEs and ACEs intersect to jointly impact school readiness. We hypothesize that, independent of and across varying exposure to ACEs, children with higher levels of PECEs will be more likely to be on track for school readiness. Study findings could inform efforts by clinical, education, and community stakeholders to improve children’s health and development.
METHODS
Sample
The current study draws on five consecutive cohorts (2016–2020) of the National Survey of Children’s Health (NSCH), a cross-sectional survey of non-institutionalized U.S. children ages 0–17 years described in-depth elsewhere.31 This web and mail-based survey queried parents or caregivers about the health, development, and socio-contextual characteristics of one, randomly selected focal child in the household. The survey oversampled children ages 0–5 and those with special healthcare needs and was designed to generate nationally representative estimates through post-stratification adjustment and sample weights accounting for differential selection and non-response. We restricted our analysis to 3- to 5-year-olds as school readiness questions were only asked for this group, resulting in a pooled sample size of 26,871 (2016 N = 7,565; 2017 N = 3,219; 2018 N = 4,618; 2019 N = 4,705; 2020 N = 6,764).
Measures
School Readiness.
Consistent with conceptualizations of school readiness as a global indicator spanning multiple domains of child development,7,29 our primary outcome was a school readiness measure previously described as “Healthy and Ready to Learn” (HRL).1,2,4,32 The pilot HRL measure was developed based on 2016 NSCH data through a comprehensive approach including stakeholder engagement, item-level analysis, and confirmatory factor analysis, with the goal of developing a maternal-child health national outcome measure.2 We employed the four domains described by Ghandour and colleagues:2 early learning skills, self-regulation, sociale-motional development, and physical health & motor development. Also following Ghandour et al.,2 children were categorized into age-appropriate categories of “at-risk” (0), “needs support” (1), or “on-track” (2) for every item. Subsequently, scores on items were then cumulatively summed to develop categories of “at-risk”, “needs support”, or “on-track” for each domain; children meeting on-track criteria for all four domains were defined as HRL. Importantly, HRL is a novel measure undergoing continuous improvement; additional measurement details can be found in prior studies.4,21
Positive Early Childhood Experiences (PECEs).
Extending prior work among 6–17 year-old children3,27 to the preschool-age population, we examined experiences known to support child development, hereinafter “PECEs”, within four domains. These included nurturing relationships, home learning opportunities, safe and stable environments, and family routines. Due to space constraints, our approach for scoring and categorizing each construct and constituent variable is briefly described below and in-depth in Appendix 1.
Nurturing Relationships.
This domain encompassed one construct, family resilience, operationalized by four items on the frequency of (1) “[talking] together about what to do,” (2) “[working] together to solve our problems,” (3) “[knowing] we have strengths to draw on,” and (4) “[staying] hopeful even in difficult times” when they face problems with response. Families were classified as either high (42%) or low (58%) family resilience.
Home Learning Opportunities.
This domain consisted of reading and singing/storytelling, based on two items asking caregivers how many past-week days did they or other family members “read” or “tell stories or sing songs”, respectively, to the focal child. Families were classified as having high (32%) or low (68%) home learning opportunities.
Safe and Stable Environments.
This domain covered three constructs: neighborhood safety, neighborhood social support, and household food security. Neighborhood safety was operationalized based on parents’ response whether the child “is safe in our neighborhood”; respondents were classified into high (67%) vs. low neighborhood safety (33%). Neighborhood social support was defined based on three items asking caregivers the extent to which people (1) “help each other out”, (2) “watch out for each other’s children”, and (3) “when we encounter difficulties, we know where to go for help” in their neighborhood. Families were then classified into high (30%) or low (70%) neighborhood social support. Household food security drew from an item asking parents to “[describe] your household’s ability to afford the food you need” in the past year. Households were categorized as food-secure (75%) vs. food-insecure (25%).
Family Routines.
This domain spanned two constructs, regular family meals and consistent bedtime. For the first construct, parents were asked the number of past-week days where “all the family members who live in the household eat a meal together”, and were then categorized into high (53%) vs. low frequency (47%) family meals. For the second construct, parents were asked how often the child “[goes] to bed at about the same time on weeknights”. Respondents were classified into consistent (35%) vs. inconsistent (65%) bedtimes.
A composite PECEs measure was created through summing the seven binary indicators below across outlined domains. Children were then categorized as low PECEs (≤1 PECE; ~17%), moderate PECEs (≥2 PECEs and ≤5 PECEs; ~ 67%), and high PECEs (≥6 PECEs; ~16%). This approach placed the low and high PECEs cut-off at approximately one standard deviation away from the mean.
Adverse Childhood Experiences (ACEs).
We examined the following nine lifetime reports of ACEs aligned with prior work:4,22 (1) economic hardship (i.e., very hard to cover basics, like food or housing, on the family’s income “somewhat often” or “very often”), (2) parent or guardian divorced or separated, (3) parent died, (4) parent served time in jail, (5) saw or heard parents or adults slap, hit, kick, or punch one another in the home, (6) was a victim of violence, or witnessed violence, in the neighborhood, (7) lived with anyone who was mentally ill, suicidal, or severely depressed, (8) lived with anyone who had a problem with alcohol or drugs, and (9) treated or judged unfairly because of his or her race or ethnic group. We summed ACEs and then categorized respondents into 0 (~71%), 1 (~18%), or 2+ ACEs (~11%).
Sociodemographic characteristics.
We examined demographic and contextual factors for inclusion as covariates in multivariable models, selecting and classifying these variables in accordance with previous studies.4,21 These spanned child (age, sex, race/ethnicity [Black, Hispanic/Latinx, Asian/Pacific Islander, Native American, Multiracial, Other, White], firstborn status, schooling status, and children with special healthcare needs (CSHCN) status [defined using U.S. Maternal-Child Health Bureau criteria33]); parent (education, marital status, primary caregiver status, maternal age) and household (poverty ratio based on federal poverty level [FPL], primary language) characteristics. Of note, we included the social construct of race/ethnicity in covariate-adjusted and stratified analyses in order to clarify possible interventions to narrow school readiness disparities.7,18,27
Data Analysis
First, we calculated descriptive statistics for demographic characteristics and HRL status, initially for the full sample and then for subsamples stratified by PECEs. Second, we examined bivariate associations between PECEs and HRL status across ACE groups. Third, we estimated multivariable logistic regression models to calculate adjusted Odds Ratios (aORs) and 95% confidence intervals (CIs) of the PECEs-HRL association, for both the full and ACE group samples. Within full sample models, we undertook a stepwise approach initially adjusting for covariates alone, then for covariates with cumulative ACEs to ascertain whether estimates were robust to possible correlations between PECEs and ACEs. As a final test of robustness, we estimated multivariable logistic regression models of the PECEs-HRL relationship, stratified by child age, sex, race/ethnicity, and household income. We also carried out supplementary analyses to examine the PECE-HRL relationship by specific ACE types utilized elsewhere34 (economic hardship, parent death/divorce, parental incarceration, violence exposure, and family mental illness) and also examined whether findings were robust to exclusion of CSHCN
Multivariable models were adjusted for survey state, year, and sample weights to permit calculation of nationally representative estimates. We used multiple imputation in multivariable analyses to handle missing data (chained equations,35 20 imputations). Results were invariant to a replication analysis using listwise deletion and to the number of imputations performed (described further in Appendix 2). All analyses were conducted in STATA Version 17.1 (College Station, TX). The University of Minnesota Institutional Review Board deemed the study exempt from human subjects review.
RESULTS
The full sample (N = 26,871) had an average age of 4 years, was 51.8% male, and 64.5% White. The next most common racial/ethnic groups were Hispanic/Latinx (12.1%), Multiracial (9.0%), and Black (6.5%). Most children had begun some form of schooling such as preschool (68.1%) and about 14.8% were CSHCN. 1 in 10 children were in households below the poverty line. 17.9% had experienced one ACE and 10.9% reported 2+ ACEs. Additional demographic details are in Table 1.
Table 1.
Sociodemographic characteristics among children ages 3–5, overall and by positive early childhood experiences – National Survey of Children’s Health, United States, 2016–2020
| Positive Early Childhood Experiences (PECEs) | ||||
|---|---|---|---|---|
| Full Sample (N = 26,871) | Low (N = 4,673) | Moderate (N = 18,006) | High (N = 4,192) | |
| Variables | Mean (SD) or % | Mean (SD) or % | Mean (SD) or % | Mean (SD) or % |
| Healthy and Ready to Learn | ||||
| No | 60.38% | 77.85% | 60.06% | 42.29% |
| Yes | 39.62% | 22.15% | 39.94% | 57.71% |
| Covariates | ||||
| Age | 4.00 (0.82) | 4.03 (0.81) | 4.00 (0.82) | 3.96 (0.82) |
| Sex (Male = 1) | 51.77% | 51.74% | 51.90% | 51.19% |
| White | 64.50% | 54.92% | 65.06% | 72.71% |
| Black | 6.47% | 9.18% | 6.33% | 4.08% |
| Hispanic/Latinx | 12.05% | 14.96% | 11.88% | 9.54% |
| Asian/Pacific Islander | 5.79% | 7.15% | 5.50% | 5.51% |
| Native American | 0.83% | 1.16% | 0.82% | 0.50% |
| Multiracial | 8.95% | 10.96% | 8.95% | 6.73% |
| Other Race/Ethnicity | 1.41% | 1.67% | 1.46% | 0.93% |
| Child Firstborn | 54.19% | 52.60% | 53.96% | 56.97% |
| Child Schooling Status | 68.05% | 65.27% | 67.81% | 72.16% |
| Child Special Healthcare Needs | 14.79% | 19.65% | 14.35% | 11.31% |
| FPL < 100% | 10.14% | 14.92% | 9.64% | 6.97% |
| FPL 100–199% | 17.12% | 24.12% | 16.59% | 11.59% |
| FPL 200–399% | 35.28% | 35.72% | 35.47% | 34.02% |
| FPL 400%+ | 37.46% | 25.25% | 38.31% | 47.42% |
| English as primary household language | 92.52% | 90.82% | 92.56% | 94.25% |
| Household Size | 4.08 (1.06) | 4.11 (1.19) | 4.08 (1.05) | 4.05 (0.94) |
| Maternal Age | 30.22 (5.52) | 29.61 (5.90) | 30.27 (5.49) | 30.70 (5.14) |
| Parent Education | 6.25 (1.85) | 5.86 (1.88) | 6.28 (1.85) | 6.59 (1.75) |
| Parent Martial Status (Married = 1) | 80.62% | 68.54% | 81.88% | 88.69% |
| Parent Primary Caregiver Status | 92.46% | 88.70% | 92.89% | 94.77% |
| Adverse Childhood Experiences (ACEs) | ||||
| None | 71.29% | 51.00% | 73.10% | 86.16% |
| 1 | 17.85% | 26.96% | 17.28% | 10.09% |
| 2+ | 10.86% | 22.04% | 9.62% | 3.75% |
Note. HRL: Healthy and Ready to Learn
39.6% of children were designated as HRL, which differed by levels of exposure to PECEs (low: 22.2%, moderate: 39.9%, high: 57.7%; Table 1). Experiencing high PECEs varied by several sociodemographic characteristics. Specifically, children who were White, enrolled in some form of schooling, did not experience ACEs or special healthcare needs, or lived in homes with higher income, married, primarily English-speaking, and more educated parents were more likely to have high PECEs. Bivariate analyses showed that across levels of ACE exposure, children were more likely to be school ready as their PECEs increased in a graded fashion (Figure 1). For instance, among children with 2+ ACEs, 15.1% of those with low PECEs were ready for school, compared with 43.3% among those with high PECEs. A similar pattern emerged for children with 0 or 1 ACEs, although there was an overall trend of lower proportions of children being HRL as ACEs increased.
Figure 1.
Prevalence of children meeting criteria for school readiness (Healthy and Ready to Learn) among children ages 3–5, by positive early childhood experiences – National Survey of Children’s Health, United States, 2016–2020
Note. ACE: Adverse childhood experience
Our multivariable regression analyses estimated that, compared with children with low PECEs, children with moderate (aOR: 2.19, 95% CI:1.86, 2.58) and high (aOR: 4.37, 95% CI: 3.58, 5.34) PECEs had greater odds for being HRL, adjusting for baseline covariates (Model 1, Table 2). Estimated effects were robust to including a measure of cumulative ACEs, attenuating only minimally (moderate PECEs aOR: 2.11, 95% CI: 1.79, 2.48; high PECEs aOR: 4.13, 95% CI: 3.38, 5.04; Model 2, Table 2). The adjusted models also continued to demonstrate consistent PECE-HRL associations when stratified by cumulative ACE levels (Models 3–5, Table 2). As well, significant PECE-HRL relationships largely held for specific ACE types; for example, children with high PECEs who had gone through parent death or divorce were 4.3 times more likely to be HRL compared with low PECE counterparts (Appendices 3–4).
Table 2.
Estimates from logistic regression models for the association between positive early childhood experiences and school readiness (Healthy and Ready to Learn) among children ages 3–5, adjusting for and stratified by adverse childhood experiences – National Survey of Children’s Health, United States, 2016–2020
| Healthy and Ready to Learn (HRL) | |||||
|---|---|---|---|---|---|
| Full Sample | Number of ACEs | ||||
| (N = 26,871) | None (N = 19,157) |
1 (N = 4,795) |
2+ (N = 2,919) |
||
| Variables | Model 1 aOR CI |
Model 2 aOR CI |
Model 3 aOR CI |
Model 4 aOR CI |
Model 5 aOR CI |
| Positive early childhood experiences | |||||
| Moderatea | 2.19** 1.86–2.58 |
2.11** 1.79–2.48 |
2.21** 1.82–2.70 |
2.12** 1.49–3.01 |
2.12** 1.40–3.21 |
| Higha | 4.37** 3.58–5.34 |
4.13** 3.38–5.04 |
4.20** 3.34–5.28 |
4.99** 3.03–8.20 |
4.39** 2.14–8.97 |
| Covariates | |||||
| Age | 1.19** 1.10–1.28 |
1.19** 1.10–1.28 |
1.14** 1.05–1.24 |
1.25* 1.05–1.50 |
1.35** 1.08–1.68 |
| Male | 0.71** 0.64–0.80 |
0.71** 0.64–0.79 |
0.71** 0.63–0.80 |
0.72* 0.55–0.95 |
0.59** 0.42–0.83 |
| Blackb | 1.22 0.99–1.50 |
1.21 0.98–1.49 |
1.11 0.86–1.44 |
1.75** 1.15–2.65 |
0.90 0.53–1.54 |
| Hispanic/Latinxb | 0.98 0.82–1.18 |
0.98 0.82–1.17 |
0.97 0.89–1.05 |
1.06 0.71–1.59 |
1.23 0.74–2.06 |
| Asian/Pacific Islanderb | 0.87 0.68–1.13 |
0.86 0.67–1.11 |
0.98 0.75–1.28 |
0.50 0.23–1.08 |
0.67 0.19–2.36 |
| Native Americanb | 0.77 0.33–1.78 |
0.79 0.35–1.79 |
1.04 0.31–3.47 |
0.81 0.22–2.93 |
0.15* 0.03–0.76 |
| Multiracialb | 1.28** 1.05–1.56 |
1.30** 1.06–1.59 |
1.38* 1.08–1.78 |
1.38 0.88–2.16 |
0.95 0.56–1.58 |
| Other Race/Ethnicityb | 1.43 0.87–2.35 |
1.38 0.85–2.26 |
1.45 0.82–2.57 |
0.96 0.40–2.33 |
0.79 0.26–2.42 |
| Child Schooling Status | 1.42** 1.25–1.62 |
1.44** 1.26–1.63 |
1.36** 1.18–1.57 |
1.63** 1.17–2.28 |
1.91** 1.32–2.75 |
| Child Special Healthcare Needs | 0.29** 0.25–0.34 |
0.30** 0.26–0.35 |
0.35** 0.30–0.42 |
0.22** 0.15–0.33 |
0.22** 0.14–0.35 |
| FPL 100–199%c | 1.39** 1.11–1.73 |
1.37** 1.09–1.71 |
1.34 0.97–1.85 |
1.88** 1.26–2.81 |
0.96 0.61–1.50 |
| FPL 200–3 99%c | 1.39** 1.13–1.72 |
1.37** 1.10–1.69 |
1.28 0.96–1.72 |
2.09** 1.36–3.21 |
0.90 0.55–1.48 |
| FPL 400%+c | 1.68** 1.33–2.11 |
1.61** 1.27–2.04 |
1.46* 1.08–1.98 |
2.52** 1.53–4.14 |
1.46 0.78–2.74 |
| English as Primary Household Language | 1.75** 1.37–2.24 |
1.80** 1.41–2.29 |
1.90** 1.44–2.50 |
1.50 0.89–2.52 |
2.50* 1.15–5.51 |
| Household Size | 0.92* 0.86–0.99 |
0.92* 0.86–0.99 |
0.97 0.89–1.05 |
0.90 0.78–1.04 |
0.80* 0.68–0.96 |
| Maternal Age | 1.01 1.00–1.02 |
1.01 0.99–1.02 |
1.01 1.00–1.03 |
1.01 0.99–1.04 |
0.99 0.96–1.02 |
| Parent Education | 1.09** 1.05–1.13 |
1.09** 1.05–1.13 |
1.11** 1.07–1.16 |
1.05 0.97–1.13 |
1.13** 1.03–1.23 |
| Parent Marital Status (Married = 1) | 1.04** 0.87–1.23 |
0.94 0.79–1.13 |
1.07 0.83–1.37 |
0.92 0.66–1.26 |
0.68 0.45–1.03 |
| Parent Primary Caregiver Status | 1.22 0.98–1.52 |
1.10 0.88–1.38 |
0.91 0.63–1.31 |
1.20 0.80–1.80 |
0.98 0.64–1.49 |
| Adverse childhood experiences | |||||
| 1 | - | 1.00 0.85–1.18 |
- | - | - |
| 2+ | - | 0.59** 0.48–0.72 |
- | - | - |
Note.
p < 0.01;
p < 0.05.
OR: adjusted Odds Ratio. CI: Confidence Interval. ACE: Adverse childhood experience.
Reference category is “Low”.
Reference Category is “White”.
Reference category is “FPL < 100%”.
Finally, we observed associations between moderate and high PECEs with school readiness. The associations remained significant within select examined demographic subgroups (i.e., age, sex, race/ethnicity, household income), with point estimates varying slightly (Table 3). Relatively larger effect sizes were observed among each group of non-White children compared with White children, although these estimates were more imprecise. There were also increasing effect sizes as household income decreased. For example, when high PECEs were present, children in the highest household income group (>400% FPL) had a 272% increased likelihood for being HRL compared with 433% increased odds for children in the lowest income group (<100% FPL). Findings were substantively similar when analyses were replicated excluding CSHCN (not shown).
Table 3.
Estimates from logistic regression models for the association between positive early childhood experiences and school readiness (Healthy and Ready to Learn) among children ages 3–5, stratified by child age, sex, race/ethnicity, and household income – National Survey of Children’s Health, United States, 2016–2020
| Healthy and Ready to Learn (HRL) | |||||
|---|---|---|---|---|---|
| PECEs | 3 years-old aOR 95% CI |
4 years-old aOR 95% CI |
5 years-old aOR 95% CI |
||
| Moderatea | 1.82** 1.38–2.39 |
2.41** 1.73–3.36 |
2.28** 1.78–2.91 |
- | - |
| Higha | 3.72** 2.67–5.18 |
4.76** 3.27–6.95 |
4.51** 3.23–6.29 |
- | - |
| N | 9,011 | 8,940 | 8,920 | - | - |
| PECEs | Male aOR 95% CI |
Female aOR 95% CI |
|||
| Moderatea | 2.28** 1.78–2.94 |
2.14** 1.73–2.63 |
- | - | - |
| Higha | 4.18** 3.11–5.60 |
4.68** 3.57–6.13 |
- | - | - |
| N | 13,910 | 12,961 | - | - | - |
| PECEs | White aOR 95% CI |
Black aOR 95% CI |
Hispanic/Latinx aOR 95% CI |
Asian/Pacific Islander aOR 95% CI | Multiracial aOR 95% CI |
| Moderatea | 1.90** 1.58–2.28 |
2.37** 1.53–3.70 |
2.27** 1.43–3.60 |
2.01* 1.10–3.68 |
3.01** 1.94–4.65 |
| Higha | 3.58** 2.87–4.46 |
5.52** 2.96–10.29 |
5.00** 2.80–8.95 |
3.98** 1.91–8.30 |
7.21** 3.80–13.71 |
| N | 18,281 | 1,739 | 3,238 | 1,555 | 2,406 |
| PECEs | FPL < 100% aOR 95% CI |
FPL 100–199% aOR 95% CI |
FPL 200–399% aOR 95% CI |
FPL 400%+ aOR 95% CI |
|
| Moderatea | 2.38** 1.57–3.61 |
2.19** 1.52–3.15 |
2.17** 1.66–2.84 |
1.98** 1.52–2.58 |
- |
| Higha | 5.33** 3.06–9.33 |
4.34** 2.69–6.99 |
4.27** 3.10–5.88 |
3.72** 2.76–5.04 |
- |
| N | 2,724 | 4,600 | 9,481 | 10,066 | - |
Note.
p < 0.01;
p < 0.05.
aOR: Adjusted Odds Ratio. CI = Confidence Interval. PECE: Positive early childhood experience.
Reference category is “Low”. The following covariates are included in all models: child age (in years), child sex (male = 1), child race/ethnicity (Black, Hispanic/Latinx, Asian/Pacific Islander, Native American, Multiracial, and Other Race/Ethnicity, with White as the reference category), child firstborn (including only children), child schooling status (child currently enrolled in school, such as preschool or pre-K), child special healthcare needs (as identified on the screener), household poverty ratio (Federal Poverty Level 100–199%, 200–399%, and 400+%, with below the poverty line as the reference category), English as the primary household language, maternal age (in years), parent education, parent marital status, and parent primary caregiver status. Estimates are weighted to represent the U.S. population of noninstitutionalized children ages 3–5 in each of the subsamples. Models adjust for state-specific and year-specific effects. Estimates represent results from the NSCH 2016–2020 surveys. Given the very small proportion of children who were Native American or in the other race/ethnicity category (~ 1% each), we were unable to examine the association between PECEs and HRL (adjusting for covariates) among these subsamples.
DISCUSSION
Similar to prior studies,1 this descriptive analysis found that approximately 2 in 5 U.S. children were HRL, possessing the developmental capacities critical for transitioning to school. Higher levels of school readiness were observed as PECEs accumulated, which was consistent across demographic groups and persisted regardless of the specific types or quantity of ACEs children faced. Further, families with relative disadvantages (i.e., non-White, low household income) experienced greater odds for being HRL as PECEs increased, despite generally lower levels of PECEs among these groups. Together, the findings lend credence to decades of literature documenting that PECEs such as reading and singing,36 family routines,37 and food security38 facilitate the acquisition of functions important for educational success. PECEs appear to support school readiness for children of all backgrounds, but may matter more so for families who hold baseline forms of social and economic marginalization.8,18,39 Greater attention to creating PECE-rich conditions for children in less resourced families, therefore, represents a vital step towards educational and health equity in the U.S.9,27
Our findings further corroborate prior investigations of NSCH data. Analyses of children aged 6–17 documented how positive childhood experiences may attenuate the threats of ACEs on school-related outcomes.3,26 Among 3–5 year-olds, various health, family, and neighborhood factors were found to correlate with school readiness and self-regulation, including some of the variables examined herein (e.g., reading).1,23 The present study extends both streams of research through conceptually bundling socio-ecological protective factors into actionable PECE categories, jointly examining ACEs and PECEs, and analyzing children prior to entering the formal schooling years.
Implications for Practice and Policy
Through examining a wide range of PECE categories, we cast light on numerous modifiable points to promote school readiness, with potential roles for multiple stakeholders. Healthcare and other child-serving providers can apply our findings within routine care settings (e.g., pediatric primary care) to optimize child health and development.7,29 For example, screening for both PECEs and ACEs40–42 can foster family engagement and afford useful clinical information to guide intervention and referrals when indicated (e.g., nutrition assistance) that ultimately may bolster overall health and school readiness. Service providers can also help children prepare for school through counseling and anticipatory guidance on PECE topics such as consistent bedtimes43 and parent-child interactions44, and integrating research-tested interventions into care settings targeting PECE domains (e.g., literacy promotion45 and parenting46 programs).
From a systems level, findings point to cross-sector, socio-ecological opportunities to enhance school readiness through augmenting PECEs. Formalized early childhood programs such as family home visiting, Head Start, and high-quality preschool consistently demonstrate positive impacts on school readiness dimensions.7,8,18,47,48 The benefit of such programs may operate through PECEs, such as promoting singing/storytelling or family resilience.39 Unfortunately, the U.S. early childhood system of care has been chronically underfunded with noteworthy quality and accessibility disparities across racial/ethnic, regional, and socioeconomic categories.7,18,29,47 Thus, our findings underscore both the need to embolden structural investments into early childhood programs while also implying that even families with limited current access can help children be optimally ready for school through focusing on PECEs (e.g., regular family meals). Beyond the NSCH, greater incorporation of PECEs into public health (e.g., surveillance systems) and education (e.g., kindergarten entry assessments) data collections from individual to aggregate scales could complement efforts to assess childhood risk and illness, possibly revealing novel pathways to optimize holistic well-being.7,12,42 Finally, our analyses reveal that certain PECEs are relatively less common nationwide (e.g., high home learning opportunities or neighborhood social support only present for one-third of children); prioritizing such PECEs via programs and policies could help enhance population-wide school readiness.
Despite this study’s potential applications, limitations are present. First, the NSCH is a cross-sectional dataset precluding the ability to infer temporality or causality. Future longitudinal and causal-oriented studies would help enhance understanding of how positive and adverse childhood experiences relate to school readiness to guide clinical and public health action. The survey is also parent-reported, therefore children’s experiences with PECEs, ACEs, and school readiness skills only reflect parents’ perspectives and may be subject to recall and social desirability biases. Although prior work supports the validity of parent self-report for many examined variables,2,49 future investigations incorporating educator assessments and observational measures of child behavior may be useful. Additionally, although the HRL measure is a promising instrument that has undergone a substantial development process, it nonetheless remains a relatively new school readiness indicator warranting a circumspect approach.1,2 It would be valuable to ascertain whether findings change as the HRL measure undergoes further refinement. Integration of qualitative studies with families, educators, and health care providers may also reveal additional insights. Relatedly, certain measures in the NSCH, although employed previously (e.g., family resilience12), should be interpreted cautiously until formal validation takes place. Finally, although findings suggest that the presence of ACEs does not void PECEs’ positive influences on school readiness, ACEs remain an imperative public health threat to address.
Our findings suggest that advances in school readiness are possible for children of diverse socio-contextual backgrounds, and these gains are not nullified even by multiple co-occurring adversities. Stakeholders across the social ecology all have roles to play in leveraging PECEs such as nurturing relationships, home learning opportunities, safe and stable environments, and family routines to realize school readiness for a greater share of the nation’s children.
Supplementary Material
What’s Known on This Subject.
A child’s readiness to enter kindergarten is a critical marker and determinant of health, academic, and socioeconomic outcomes throughout the life course, with noteworthy variation in school readiness based on demographic factors such as race/ethnicity and household income.
What This Study Adds.
Higher levels of positive early childhood experiences (e.g., family routines) are associated with greater school readiness within a nationally generalizable sample of children, even when adjusting for adversity exposure. This relationship holds across sociodemographic groups and degrees of adversity.
Acknowledgments
We thank Leslie Salas-Hernandez, PhD, MPH, for her guidance in conceptualizing this study. A preliminary version of this analysis was presented at the Society for Research in Child Development Biennial Conference in 2021.
Funding/Support
We acknowledge support from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health & Human Development (#P2CHD041023) for Marvin So’s contributions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, HRSA, or U.S. Government.
Abbreviations
- aOR
Adjusted Odds Ratio
- ACE
Adverse childhood experience
- CI
Confidence interval
- FPL
Federal poverty level
- HRL
Healthy and Ready to Learn
- K-12
Kindergarten to 12th grade
- NSCH
National Survey of Children’s Health
- PECE
Positive early childhood experience
Footnotes
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Conflicts of Interest
The authors have nothing to disclose.
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