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Background: In Australia, the health and education sectors provide universal early childhood services for the same population of children. Therefore, there is a strong imperative to view service use and outcomes through a cross-sectoral lens to better understand and address the service needs of young children and their families., Objectives: To investigate patterns of health and education service use from birth through Kindergarten (age four years), the associations with cumulative risks, and developmental vulnerability in the first year of full-time school (age five years)., Methods: A retrospective cohort study that used population-wide linkage of health and education administrative data records for 5,440 children with a Tasmanian 2015 Australian Early Development Census (AEDC) record who were born in Tasmania (2008-2010)., Results: Four service use patterns were identified: Regular (46% of children), Declining (24%); Low (18%); and Selective service use (12%). Regular service use (aOR 0.8, 95% CI 0.7 to 0.9), adjusted for cumulative risks, was associated with decreased odds of developmental vulnerability, compared to the other service use groups. Low (OR 6.1, 95% CI 4.5 to 8.2) and Declining service use (OR 2.5 95% CI 1.9 to 3.4) were more likely for children with the highest levels of cumulative risks. Low and Declining service use, adjusted for cumulative risks were associated with increased odds of developmental vulnerability, compared to the Regular service use group., Conclusion: This study provides a whole population view of the differential use of universal services and the complex risk circumstances that influence service use. The association between patterns of multiple risk and service use points to barriers to service use, and the varying level of developmental vulnerability within each service use group draws attention to children who may benefit from higher sustained participation in core health and education services across the whole of early childhood., Competing Interests: Statement on conflicts of interest: The authors declare they have no conflicts of interest.

Objective: To investigate the prevalence of, and associations between, prenatal and perinatal risk factors and developmental vulnerability in twins at age 5., Design: Retrospective cohort study using bivariate and multivariable logistic regression., Setting: Western Australia (WA), 2002-2015., Participants: 828 twin pairs born in WA with an Australian Early Development Census (AEDC) record from 2009, 2012 or 2015., Main Outcome Measures: The AEDC is a national measure of child development across five domains. Children with scores <10th percentile were classified as developmentally vulnerable on, one or more domains (DV1), or two or more domains (DV2)., Results: In this population, 26.0% twins were classified as DV1 and 13.5% as DV2. In the multivariable model, risk factors for DV1 were maternal age <25 years (adjusted OR (aOR): 7.06, 95% CI: 2.29 to 21.76), child speaking a language other than English at home (aOR: 6.45, 95% CI: 2.17 to 19.17), male child (aOR: 5.08, 95% CI: 2.89 to 8.92), age younger than the reference category for the study sample (≥5 years 1 month to <5 years 10 months) at time of AEDC completion (aOR: 3.34, 95% CI: 1.55 to 7.22) and having a proportion of optimal birth weight (POBW) <15th percentile of the study sample (aOR: 2.06, 95% CI 1.07 to 3.98). Risk factors for DV2 were male child (aOR: 7.87, 95% CI: 3.45 to 17.97), maternal age <25 (aOR: 5.60, 95% CI: 1.30 to 24.10), age younger than the reference category (aOR: 5.36, 95% CI: 1.94 to 14.82), child speaking a language other than English at home (aOR: 4.65, 95% CI: 1.14 to 19.03), mother's marital status as not married at the time of twins' birth (aOR: 4.59, 95% CI: 1.13 to 18.55), maternal occupation status in the lowest quintile (aOR: 3.30, 95% CI: 1.11 to 9.81) and a POBW <15th percentile (aOR: 3.11, 95% CI: 1.26 to 7.64)., Conclusion: Both biological and sociodemographic risk factors are associated with developmental vulnerability in twins at 5 years of age., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Early childhood is a critical time to address risk factors associated with developmental vulnerability. This study investigated the associations between clusters of early life risk factors and developmental vulnerability in children's first year of full-time school at age 5., Design: A retrospective cohort study., Setting: Population-wide linkage of administrative data records for children born in Tasmania, Australia in 2008-2010., Participants: The cohort comprised 5440 children born in Tasmania in 2008-2010, with a Tasmanian 2015 Australian Early Development Census (AEDC) record and a Tasmanian Perinatal Collection record., Outcome Measure: The AEDC is a national measure of child development across five domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who scored below the 10th percentile on one or more AEDC domains were classified as developmentally vulnerable. Children with special needs are not included in the AEDC results., Results: Latent class analysis identified five clusters of risk factors: low risks (65% of children), sociodemographic and health behaviour risks (24%), teenage mother and sociodemographic risks (6%), birth risks (3%), and birth, sociodemographic and health behaviour risks (2%). In this sample population, 20% of children were classified as developmentally vulnerable, but the proportion varied substantially by latent class. Logistic regression showed increased odds of developmental vulnerability associated with sociodemographic and health behaviour risks (OR 2.26, 95% CI 1.91 to 2.68, p<0.001), teenage mother and sociodemographic risks (OR 2.01, 95% CI 1.50 to 2.69, p<0.001), and birth, sociodemographic and health behaviour risks (OR 3.29, 95% CI 2.10 to 5.16. p<0.001), but not birth risks (OR 1.34, 95% CI 0.88 to 2.03, p=0.1649), relative to the reference group., Conclusions: The patterning of risks across the five groups invites consideration of multisectoral policies and services to address complex clusters of risk factors associated with developmental vulnerability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Book reading is one of the most important investments that parents make in their children's literacy development. This study investigated risk factors associated with the absence of book reading at ages 2, 4 and 6 years. A holistic view of the multiple ecologies of child development guided the study across a sample of approximately 4000 children from the Longitudinal Study of Australian Children. Eight potential risk factors for the absence of book reading were examined in a multivariate logistic regression analysis and in a cumulative risk approach. The magnitude of association between individual risk factors and the absence of book reading varied at different ages. However, across all ages, there was a consistent association between multiple risk exposures and the absence of book reading. The results suggest that the absence of book reading may serve as a red flag for multiple disadvantages. For this reason, parent-child book reading interventions alone are unlikely to meet the needs of children and families for whom the absence of book reading is an outcome of psychosocial risk factors.

There is a large volume of research on the persistence of advantage and disadvantage across generations. Intergenerational studies typically address family resources as independent factors, which ignores how risks cluster together and accumulate over time. Using data from the Longitudinal Study of Australian Children, we conducted two latent class analyses to separately identify latent classes based on grandparent and parent characteristics for study children. We then examined the association between our identified latent classes and grandchild educational outcomes in Years 3 to 9. Five distinct latent classes of grandparent characteristics and four latent classes of parent characteristics were identified. There was association between parent and grandparent latent classes indicating intergenerational multiple disadvantage. Grandchildren in at‐risk parent latent classes tended to have significantly lower literacy and numeracy scores from Years 3 to 9. The effects of grandparent latent classes were inconsistent. The developmental circumstances of children can be defined using the characteristics of both parents and grandparents, and the role of grandparents on children's development extends beyond the influence they have on parent outcomes. This study highlights that addressing intergenerational transfers of disadvantage requires multiple, integrated and coordinated policy approaches that go beyond individual indicators of disadvantage. [ABSTRACT FROM AUTHOR]

This study investigated patterns of universal health and education service use from birth through Kindergarten (age 4 years) and estimated associations between cumulative risk and service use patterns, and between service use patterns and children's developmental vulnerability in the Preparatory Year (age 5 years). The study used population‐wide linkage of health and education administrative data records for 5168 children who had a 2018 AEDC instrument collected in Tasmania and were born in Tasmania (2011–2013). Latent class analysis (LCA) identified three service use patterns: Regular (72.2 per cent of children; reference group), Low (15.6 per cent of children) and High service use (12.2 per cent of children). The patterns of Regular, Low and High service use were consistent across health and education services used at different ages and stages of child development. Membership of the Low and High service use groups was associated with higher cumulative risk and increased odds of developmental vulnerability, relative to the Regular service use group. This population‐wide view of universal service use can be used by the health and education sectors to explore ways in which their specialist expertise, resources and referral processes can be further integrated within and across services to meet the developmental needs of children and families. [ABSTRACT FROM AUTHOR]

Tasmania’s child and family centres (Centres) provide a single entry point to early childhood services (ECS) for children and families living in amongst the most disadvantaged communities in Australia. This study investigated the impact of Centres on parents’ use and experiences of ECS using a mixed methods approach. The results showed that Centre users made more use of ECS than did non-users. Centre users also rated their experiences of ECS more positively than non-users. For example, Centre users were more likely to report that ECS were convenient and close, committed to helping, and worked closely with one another. Centre users identified Centres as informal, accessible, responsive, non-judgemental and supportive places where they felt valued, respected and safe. Parents experienced Centres as welcoming places that were helping them to develop positive child, family, school and community connections. These qualities appeared critical for facilitating parental access and engagement in ECS. [ABSTRACT FROM PUBLISHER]

Risk exposures and predictions of child development outcomes typically estimate the independent effects of individual exposures. As a rule though, children are not exposed piecemeal to individual or single risks but, rather, they are exposed to clusters of risk. Many of these clusters of risks are better thought of as comprising a developmental “circumstance” with a substantial duration, over which period, additional risk exposures also accumulate. In this paper we examined the distribution of 16 single risk exposures for low language ability using latent class analysis across a sample of approximately 4000 children from the Longitudinal Study of Australian Children. The best fitting model identified six distinct classes. 46% of children were in a Developmentally Enabled group, 20% were in a group typified as Working Poor families, 10% of children were in group typified as Overwhelmed group, 9% of children were in a group defined by Child Developmental Delay, 8% of children were in a group defined by Low Human Capital, and 7% of children were in a group defined by Resource Poor non-English Speaking background families. These groups had quantitatively and qualitatively distinct patterns of risk factors and showed different onward trajectories of receptive vocabulary. Our results demonstrate a range of multiple risk profiles in a population-representative sample of Australian children and highlight the mix of risk factors faced by children. Children with distinct patterns of risk factors have different onward trajectories of receptive vocabulary development. [ABSTRACT FROM AUTHOR]

Aims: Oral language is the foundation of literacy. Naturally, policies and practices to promote children’s literacy begin in early childhood and have a strong focus on developing children’s oral language, especially for children with known risk factors for low language ability. The underlying assumption is that children’s progress along the oral to literate continuum is stable and predictable, such that low language ability foretells low literacy ability. This study investigated patterns and predictors of children’s oral language and literacy abilities at 4, 6, 8 and 10 years. The study sample comprised 2,316 to 2,792 children from the first nationally representative Longitudinal Study of Australian Children (LSAC). Six developmental patterns were observed, a stable middle-high pattern, a stable low pattern, an improving pattern, a declining pattern, a fluctuating low pattern, and a fluctuating middle-high pattern. Most children (69%) fit a stable middle-high pattern. By contrast, less than 1% of children fit a stable low pattern. These results challenged the view that children’s progress along the oral to literate continuum is stable and predictable. Findings: Multivariate logistic regression was used to investigate risks for low literacy ability at 10 years and sensitivity-specificity analysis was used to examine the predictive utility of the multivariate model. Predictors were modelled as risk variables with the lowest level of risk as the reference category. In the multivariate model, substantial risks for low literacy ability at 10 years, in order of descending magnitude, were: low school readiness, Aboriginal and/or Torres Strait Islander status and low language ability at 8 years. Moderate risks were high temperamental reactivity, low language ability at 4 years, and low language ability at 6 years. The following risk factors were not statistically significant in the multivariate model: Low maternal consistency, low family income, health care card, child not read to at home, maternal smoking, maternal education, family structure, temperamental persistence, and socio-economic area disadvantage. The results of the sensitivity-specificity analysis showed that a well-fitted multivariate model featuring risks of substantive magnitude did not do particularly well in predicting low literacy ability at 10 years. [ABSTRACT FROM AUTHOR]

Receptive vocabulary development is a component of the human language system that emerges in the first year of life and is characterised by onward expansion throughout life. Beginning in infancy, children's receptive vocabulary knowledge builds the foundation for oral language and reading skills. The foundations for success at school are built early, hence the public health policy focus on reducing developmental inequalities before children start formal school. The underlying assumption is that children's development is stable, and therefore predictable, over time. This study investigated this assumption in relation to children's receptive vocabulary ability. We investigated the extent to which low receptive vocabulary ability at 4 years was associated with low receptive vocabulary ability at 8 years, and the predictive utility of a multivariate model that included child, maternal and family risk factors measured at 4 years. The study sample comprised 3,847 children from the first nationally representative Longitudinal Study of Australian Children (LSAC). Multivariate logistic regression was used to investigate risks for low receptive vocabulary ability from 4–8 years and sensitivity-specificity analysis was used to examine the predictive utility of the multivariate model. In the multivariate model, substantial risk factors for receptive vocabulary delay from 4–8 years, in order of descending magnitude, were low receptive vocabulary ability at 4 years, low maternal education, and low school readiness. Moderate risk factors, in order of descending magnitude, were low maternal parenting consistency, socio-economic area disadvantage, low temperamental persistence, and NESB status. The following risk factors were not significant: One or more siblings, low family income, not reading to the child, high maternal work hours, and Aboriginal or Torres Strait Islander ethnicity. The results of the sensitivity-specificity analysis showed that a well-fitted multivariate model featuring risks of substantive magnitude does not do particularly well in predicting low receptive vocabulary ability from 4–8 years. [ABSTRACT FROM AUTHOR]

Receptive vocabulary develops rapidly in early childhood and builds the foundation for language acquisition and literacy. Variation in receptive vocabulary ability is associated with variation in children's school achievement, and low receptive vocabulary ability is a risk factor for under-achievement at school. In this study, bivariate and multivariate growth curve modelling was used to estimate trajectories of receptive vocabulary development in relation to a wide range of candidate child, maternal and family level influences on receptive vocabulary development from 4–8 years. The study sample comprised 4332 children from the first nationally representative Longitudinal Study of Australian Children (LSAC). Predictors were modeled as risk variables with the lowest level of risk as the reference category. In the multivariate model, risks for receptive vocabulary delay at 4 years, in order of magnitude, were: Maternal Non- English Speaking Background (NESB), low school readiness, child not read to at home, four or more siblings, low family income, low birthweight, low maternal education, maternal mental health distress, low maternal parenting consistency, and high child temperament reactivity. None of these risks were associated with a lower rate of growth from 4–8 years. Instead, maternal NESB, low school readiness and maternal mental health distress were associated with a higher rate of growth, although not sufficient to close the receptive vocabulary gap for children with and without these risks at 8 years. Socio-economic area disadvantage, was not a risk for low receptive vocabulary ability at 4 years but was the only risk associated with a lower rate of growth in receptive vocabulary ability. At 8 years, the gap between children with and without socio-economic area disadvantage was equivalent to eight months of receptive vocabulary growth. These results are consistent with other studies that have shown that social gradients in children's developmental outcomes increase over time. [ABSTRACT FROM AUTHOR]