Risk-based approach to school entry examinations in Germany – a validation study

Abstract

BackgroundIn Germany, all preschoolers undergo a school entry examination (SEE). While most children are sufficiently served with standardized developmental tests only, for a small group of otherwise underserved children, the SEE should also include a subsidiary health checkup. The aim of the study was to validate selection criteria to differentiate these two groups of children.MethodsSecondary data from the SEEs of 2016 and 2017 that contained information on 3513 children were analyzed. Of these children, a subset was selected in which no severe developmental disorders were diagnosed prior to the SEE (n = 2744). The selection criteria identified in an earlier study (low or medium social status, missed the last pediatric routine check-up, migration background, three or more siblings, and raised by a single mother) were then applied to this subset to estimate their effectiveness in finding children at risk for a newly diagnosed severe developmental disorder. The sensitivity, specificity and positive and negative predictive values of the selection criteria were calculated.ResultsThe tested selection criteria identified children who would likely benefit from a subsidiary checkup in the context of SEEs with a sensitivity of 96% (95% CI: 94.5–98.9%). The negative predictive value and specificity of the criteria were 99% (98.6–99.7%) and 34% (32.1–35.8%), respectively. By using this approach, the number of children seen by a physician could be reduced to 53% of the age cohorts.ConclusionThe tested selection criteria are a viable way to differentiate children for whom SEEs should include a subsidiary health checkup from those who do not need it. Therefore, the time that physicians spend with SEEs could be reduced. Using the selection criteria to establish a stepped procedure in SEEs therefore offers a valid way to focus physicians’ resources on the children who need them most.

Segregated by Wealth, Health, and Development: An Analysis of Pre-School Child Health in a Medium-Sized German City

“…Previous research has shown that the SEE can be a useful tool to identify children at higher risk of health issues and developmental delays [21][22][23].…”

Health-Related Disparities among Migrant Children at School Entry in Germany. How does the Definition of Migration Status Matter?

“…In Germany, SEEs are obligatory examinations, where all children are examined by the respective communal departments of public health (Gesundheitsamt) in the year before starting school. These checkups comprise a parental questionnaire, a standardized examination including vision, hearing, and developmental tests, and a clinical examination by the public health physician that aim to detect developmental delays which could interfere with the child's educational success [35][36][37][38], obtain epidemiological data [37,[39][40][41] and provide individual medical help to children who are otherwise underserved [42][43][44].…”

Parent, teacher, and nurse concerns and school doctor actions: an observational study of general health checks

“…In a German study, selection criteria such as low social status, missing the last paediatric routine check-up, migration background, and being raised by a single parent could differentiate children for whom school entry examination should include a health check by a physician from those with no need for one. 9 These criteria may be ethically more difficult to accept than criteria based on concerns regarding each child. Our previous research suggested that at least one in four children have no need for a health check by school doctor according to questionnaires that assess the concerns of parents, teachers, and nurses regarding each child’s physical, mental, and social health.…”

“…One issue still requiring solid evidence is whether school doctor services ought to be offered as universal health checks or as targeted interventions in response to the needs of a child. In a German study, selection criteria such as low social status, missing the last paediatric routine check-up, migration background, and being raised by a single parent could differentiate children for whom school entry examination should include a health check by a physician from those with no need for one 9. These criteria may be ethically more difficult to accept than criteria based on concerns regarding each child.…”