Numerous studies have raised alarms about how the COVID-19 pandemic disrupted learning, development and mental health among school-aged children. But few have focused on the effects felt by the 22 million children under age 6 who were not yet in school.
Now a study published Feb. 5, 2024, in JAMA Pediatrics, led by researchers at Cincinnati Children’s in collaboration with the Cincinnati Public Schools, documents the pandemic’s harmful effects on kindergarten readiness. The findings are based on data from about 8,000 kindergartners who took a state-required Kindergarten Readiness Assessment (KRA) in 2018, 2019, and 2021–including 3,200 children who receive care through Cincinnati Children’s primary care clinics.
What the researchers found was concerning. Only 30% (or 3 in 10) of Cincinnati Public Schools students were assessed as kindergarten-ready in 2021, a significant decline from 40% (or 4 in 10) assessed as ready in 2018. Researchers found a similar pattern in the 3,200 children who receive care through Cincinnati Children’s primary care sites: 21.5% deemed ready to learn in 2021 compared to 32% in 2018.
“This means that 7 of every 10 children in the Cincinnati Public Schools were considered not ready to learn when they entered kindergarten during the pandemic. This trend was even more pronounced among the more-disadvantaged, Medicaid-covered children we see in our primary care clinics,” says the study’s lead author Kristen Copeland, MD, Division of General and Community Pediatrics.
“It will take intense effort on multiple levels to help these children overcome this disruption,” Copeland says.
Pandemic amplified existing gaps
The research team drilled down on the KRA scores that involved patients cared for in Cincinnati Children’s pediatric primary care centers. This involved linking the KRA scores to other screening assessments of the child’s development and early reading exposures, as well as social, socio-economic environmental, and family characteristics and factors.
These factors included the family’s financial hardships and food security, primary language spoken at home, the child’s race and ethnicity, and maternal stress or depressive symptoms—all known to be linked to a child’s readiness to succeed in kindergarten.
The readiness assessment includes a series of 27 questions and tasks administered by teachers to measure a child’s skills in early reading, early math, gross motor and fine motor tasks, self-regulation and attention. The Cincinnati Children’s study identifies several factors generally associated with lower levels of kindergarten readiness, including:
- Child previously failed a developmental screening assessment between 18 months and 5 years of age
- Child insured by Medicaid (a proxy measure of low family income)
- Hispanic vs. non-Hispanic ethnicity
- Family requires a medical interpreter during clinic visits
- Child sex is male
- Parents report rarely reading to the child
- Family previously reported experiencing food insecurity
“To our knowledge, this is among the first and the largest studies to use real-world data to analyze protective and risk factors for school readiness among a population that has been traditionally reluctant to participate in research studies,” Copeland says.
Cause for optimism
While the lower readiness scores can be seen as distressing, the research team says many of the factors that limit readiness can be addressed because a structure for doing so already exists.
“The good news is that we identified several factors that predicted later kindergarten readiness that we already measure during primary care visits,” Copeland says. “Furthermore, we have in primary care ways to quickly get kids the additional help they need, be it speech therapy, legal aid, benefits assistance, food pantry or produce delivery, or hands-on assistance in enrolling in preschool, high quality childcare and Head Start.”
There is great potential to enhance linkages among community organizations to help families support pre-kindergarten learning and development for their children.
The co-authors say this study reflects an ongoing partnership between Cincinnati Children’s and Cincinnati Public Schools that has built bridges over the years to overcome many existing obstacles to data sharing. Expanding such relationships to other school districts and building similar collaborations in other cities will likely help even more children affected by the pandemic get back on track in school.
“These cross-sector linkages highlight the urgency for primary care organizations to become more involved in promoting equitable early child development, not just in Cincinnati but across the United States,” says co-author Robert Kahn, MD, MPH, director of the Fisher Child Health Equity Center at Cincinnati Children’s.
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