Retrospective study shows decrease in kindergarten readiness

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Primary care screening visits for young children serve as useful sources of data for social assessment and developmental markers. It is not clear how this screening data can be used to predict whether children are ready for school.

Study: Linking Health and School Data Before and During the Covid-19 Pandemic as Oriel Correlates of School Readiness.  Image credit: FamVeld/
Study: Linking Health and School Data Primary Relationships to School Readiness Before and During the Covid-19 Pandemic. Image credit: FamVeld/

A new study appears Jama Pediatrics that linked school district Early Kindergarten Readiness Assessment (KRA) and Electronic Health Records (EHR) data and KRA scores to changes that occurred during the coronavirus disease 2019 (COVID-19) pandemic.


Childhood is a watershed time for social skills, healthy physical and brain development, and school readiness. Multiple factors can interfere with the acquisition of these skills that are essential in school life, such as social training, emotional regulation, as well as math and literacy skills. These may include socioeconomic and ethnic characteristics.

In some areas, 4 out of 10 new kindergartners are not ready to enter school Because no systematic effort has been made to identify which children are at risk of entering kindergarten without reading, it is unclear how and which risk factors can be modified to change this situation.

The COVID-19 pandemic has negatively impacted the learning of school-age children, but its impact on the development of children under five remains to be described. This motivated the current study that used KRA scores with EHR data from a cohort of students in a large school district with approximately 36,000 students before and during the pandemic.

KRA scores are linked to reading skills in third grade and include four skill categories: preliteracy, premotor, motor skills, and social-emotional skills.

What does the study show?

The study included more than 3,000 patients who were screened at the primary care level. Median age was 67 months, mostly black (80%) versus 8% white. The passing KRA score was set at 270.

When correlated with the date of the epidemic, the average KRA score was significantly lower in 2021, 260, versus ~263 in 2019 and 2018. About a fifth of students in 2021 scored above the passing level, demonstrating school readiness, versus ~19% in 220 and 32% in 2018.

One in four parents said they rarely read to their child, that is, one day a week or less, at least once during the study period. About 27% of children did not meet the ASQ score at least once, while 12% of children sometimes experienced food insecurity.

Risk factors for low KRA scores were one or more failures on the ASQ between 18 and 54 months, being Hispanic, not speaking the language of the health care professional at the screening visit, being male, and rarely reading as well as dieting. Insecurity Only 23% of boys were ready for school versus 32% of girls.

Having Medicaid insurance, indicative of lower socioeconomic status, was associated with ~27% of children’s school readiness, versus ~51% if Medicaid was not used.

Other socioeconomic factors, such as housing insecurity, race, depression among caregivers, and difficulty accessing benefits, did not show any association with KRA scores.

To illustrate our results using a hypothetical clinical example, starting with an expected score of 270.8 in the adjusted model (equivalent to showing readiness): a boy with Medicaid insurance, who failed the ASQ once, who rarely reported food insecurity, and was not Read lost an average of 15 points on the KRA, placing him in the bottom category of Emerging Preparedness (score below 257).

What are the effects?

It is among the earliest studies that can report that “A detrimental association of the COVID-19 pandemic with early education and development“This is one of the largest studies to correlate primary care data with public school outcomes.

Although other researchers have found conflicting evidence regarding childhood development during the epidemic, multiple factors are at work, affecting the validity of the observed associations. For example, school enrollment rates were low during this period. However, the association of low school readiness with not reading as a child is well documented, as well as with lower developmental scores and food insecurity.

Picking up danger signals in this way can help provide appropriate interventions early in life, promoting learning through speech and language therapy, enrollment in good early childhood education programs, or facilitating library access.

These findings suggest considerable untapped potential for primary care pediatricians and school districts to work more closely together because the risks of kindergarten readiness in primary care are already evident.

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