child education case study

Early Childhood Education: How to do a Child Case Study-Best Practice

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Description of Assignment

During your time at Manor, you will need to conduct a child case study. To do well, you will need to plan ahead and keep a schedule for observing the child. A case study at Manor typically includes the following components: 

• Three observations of the child: one qualitative, one quantitative, and one of your choice. 
• Three artifact collections and review: one qualitative, one quantitative, and one of your choice. 
• A Narrative

Within this tab, we will discuss how to complete all portions of the case study.  A copy of the rubric for the assignment is attached. 

• Case Study Rubric (Online)
• Case Study Rubric (Hybrid/F2F)

Qualitative and Quantitative Observation Tips

Remember your observation notes should provide the following detailed information about the child:

• child’s age,
• physical appearance,
• the setting, and
• any other important background information.

You should observe the child a minimum of 5 hours. Make sure you DO NOT use the child's real name in your observations. Always use a pseudo name for course assignments. 

You will use your observations to help write your narrative. When submitting your observations for the course please make sure they are typed so that they are legible for your instructor. This will help them provide feedback to you. 

Qualitative Observations

A qualitative observation is one in which you simply write down what you see using the anecdotal note format listed below. 

Quantitative Observations

A quantitative observation is one in which you will use some type of checklist to assess a child's skills. This can be a checklist that you create and/or one that you find on the web. A great choice of a checklist would be an Ounce Assessment and/or work sampling assessment depending on the age of the child. Below you will find some resources on finding checklists for this portion of the case study. If you are interested in using Ounce or Work Sampling, please see your program director for a copy. 

Remaining Objective 

For both qualitative and quantitative observations, you will only write down what your see and hear. Do not interpret your observation notes. Remain objective versus being subjective.

An example of an objective statement would be the following: "Johnny stacked three blocks vertically on top of a classroom table." or "When prompted by his teacher Johnny wrote his name but omitted the two N's in his name." 

An example of a subjective statement would be the following: "Johnny is happy because he was able to play with the block." or "Johnny omitted the two N's in his name on purpose." 

• Anecdotal Notes Form Form to use to record your observations.
• Guidelines for Writing Your Observations
• Tips for Writing Objective Observations
• Objective vs. Subjective

Qualitative and Quantitative Artifact Collection and Review Tips

For this section, you will collect artifacts from and/or on the child during the time you observe the child. Here is a list of the different types of artifacts you might collect: 

Potential Qualitative Artifacts 

• Photos of a child completing a task, during free play, and/or outdoors. 
• Samples of Artwork 
• Samples of writing 
• Products of child-led activities 

Potential Quantitative Artifacts 

• Checklist 
• Rating Scales
• Product Teacher-led activities 

Examples of Components of the Case Study

Here you will find a number of examples of components of the Case Study. Please use them as a guide as best practice for completing your Case Study assignment. 

• Qualitatitive Example 1
• Qualitatitive Example 2
• Quantitative Photo 1
• Qualitatitive Photo 1
• Quantitative Observation Example 1
• Artifact Photo 1
• Artifact Photo 2
• Artifact Photo 3
• Artifact Photo 4
• Artifact Sample Write-Up
• Case Study Narrative Example Although we do not expect you to have this many pages for your case study, pay close attention to how this case study is organized and written. The is an example of best practice.

Narrative Tips

The Narrative portion of your case study assignment should be written in APA style, double-spaced, and follow the format below:

• Introduction : Background information about the child (if any is known), setting, age, physical appearance, and other relevant details. There should be an overall feel for what this child and his/her family is like. Remember that the child’s neighborhood, school, community, etc all play a role in development, so make sure you accurately and fully describe this setting! --- 1 page
• Observations of Development :   The main body of your observations coupled with course material supporting whether or not the observed behavior was typical of the child’s age or not. Report behaviors and statements from both the child observation and from the parent/guardian interview— 1.5  pages
• Comment on Development: This is the portion of the paper where your professional analysis of your observations are shared. Based on your evidence, what can you generally state regarding the cognitive, social and emotional, and physical development of this child? Include both information from your observations and from your interview— 1.5 pages
• Conclusion: What are the relative strengths and weaknesses of the family, the child? What could this child benefit from? Make any final remarks regarding the child’s overall development in this section.— 1page
• Your Case Study Narrative should be a minimum of 5 pages.

Make sure to NOT to use the child’s real name in the Narrative Report. You should make reference to course material, information from your textbook, and class supplemental materials throughout the paper . 

Same rules apply in terms of writing in objective language and only using subjective minimally. REMEMBER to CHECK your grammar, spelling, and APA formatting before submitting to your instructor. It is imperative that you review the rubric of this assignment as well before completing it. 

Biggest Mistakes Students Make on this Assignment

Here is a list of the biggest mistakes that students make on this assignment: 

• Failing to start early . The case study assignment is one that you will submit in parts throughout the semester. It is important that you begin your observations on the case study before the first assignment is due. Waiting to the last minute will lead to a poor grade on this assignment, which historically has been the case for students who have completed this assignment. 
• Failing to utilize the rubrics. The rubrics provide students with guidelines on what components are necessary for the assignment. Often students will lose points because they simply read the descriptions of the assignment but did not pay attention to rubric portions of the assignment. 
• Failing to use APA formatting and proper grammar and spelling. It is imperative that you use spell check and/or other grammar checking software to ensure that your narrative is written well. Remember it must be in APA formatting so make sure that you review the tutorials available for you on our Lib Guide that will assess you in this area. 
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Case Studies and Scenarios

Case studies.

Each case study describes the real experience of a Registered Early Childhood Educator. Each one profiles a professional dilemma, incorporates participants with multiple perspectives and explores ethical complexities. Case studies may be used as a source for reflection and dialogue about RECE practice within the framework of the Code of Ethics and Standards of Practice​.

Scenarios are snapshots of experiences in the professional practice of a Registered Early Childhood Educator. Each scenario includes a series of questions meant to help RECEs reflect on the situation.

Case Study 1: Sara’s Confusing Behaviour

Case study 2: getting bumps and taking lumps, case study 3: no qualified staff, case study 4: denton’s birthday cupcakes, case study 5: new kid on the block, case study 6: new responsibilities and challenges, case study 7: valuing inclusivity and privacy, case study 8: balancing supervisory responsibilities, case study 9: once we were friends, ​​​​scenarios​​, communication and collaboration.

Barbara, an RECE, is working as a supply staff at various centres across the city. During her week at a centre where she helps out in two different rooms each day, she finds that her experience in the school-age program isn’t as straightforward as when she was in the toddler room. Barbara feels completely lost in this program.

Do You Really Know Who Your Friends Are?

Joe is an RECE at an elementary school and works with children between the ages of nine and 12 years old. One afternoon, he finds a group of children huddled around the computer giggling and whispering. Joe quickly discovers they’re going through his party photos on Facebook as one of the children’s parents recently added him as a friend.

Conflicting Approaches

Amina, an experienced RECE, has recently started a new position with a child care centre. She’s assigned to work in the infant room with two colleagues who have worked in the room together for ten years. As Amina settles into her new role, she is taken aback by some of the child care approaches taken by her colleagues.

What to do about Lisa?

Shane, an experienced supervisor at a child care centre, receives a complaint about an RECE who had roughly handled a child earlier that day. The interaction had been witnessed by a parent who confronted the RECE. After some words were exchanged, the RECE left in tears.

Duty to Report

Zoë works as an RECE in a drop-in program at a family support centre. She has a great rapport for a family over a 10-month period and beings to notice a change in the mom and child. One day, as the child is getting dressed to go home for the day, she notices something alarming and brings it to the attention of her supervisor.

Posting on Social Media

Allie, an RECE who has worked at the same child care centre for the last three years, recently started a private social media group to collaborate and discuss programming ideas. As the group takes a negative turn with rude and offensive comments, it’s brought to her supervisor’s attention.

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Making Learning Relevant With Case Studies

The open-ended problems presented in case studies give students work that feels connected to their lives.

To prepare students for jobs that haven’t been created yet, we need to teach them how to be great problem solvers so that they’ll be ready for anything. One way to do this is by teaching content and skills using real-world case studies, a learning model that’s focused on reflection during the problem-solving process. It’s similar to project-based learning, but PBL is more focused on students creating a product.

Case studies have been used for years by businesses, law and medical schools, physicians on rounds, and artists critiquing work. Like other forms of problem-based learning, case studies can be accessible for every age group, both in one subject and in interdisciplinary work.

You can get started with case studies by tackling relatable questions like these with your students:

• How can we limit food waste in the cafeteria?
• How can we get our school to recycle and compost waste? (Or, if you want to be more complex, how can our school reduce its carbon footprint?)
• How can we improve school attendance?
• How can we reduce the number of people who get sick at school during cold and flu season?

Addressing questions like these leads students to identify topics they need to learn more about. In researching the first question, for example, students may see that they need to research food chains and nutrition. Students often ask, reasonably, why they need to learn something, or when they’ll use their knowledge in the future. Learning is most successful for students when the content and skills they’re studying are relevant, and case studies offer one way to create that sense of relevance.

Teaching With Case Studies

Ultimately, a case study is simply an interesting problem with many correct answers. What does case study work look like in classrooms? Teachers generally start by having students read the case or watch a video that summarizes the case. Students then work in small groups or individually to solve the case study. Teachers set milestones defining what students should accomplish to help them manage their time.

During the case study learning process, student assessment of learning should be focused on reflection. Arthur L. Costa and Bena Kallick’s Learning and Leading With Habits of Mind gives several examples of what this reflection can look like in a classroom: 

Journaling: At the end of each work period, have students write an entry summarizing what they worked on, what worked well, what didn’t, and why. Sentence starters and clear rubrics or guidelines will help students be successful. At the end of a case study project, as Costa and Kallick write, it’s helpful to have students “select significant learnings, envision how they could apply these learnings to future situations, and commit to an action plan to consciously modify their behaviors.”

Interviews: While working on a case study, students can interview each other about their progress and learning. Teachers can interview students individually or in small groups to assess their learning process and their progress.

Student discussion: Discussions can be unstructured—students can talk about what they worked on that day in a think-pair-share or as a full class—or structured, using Socratic seminars or fishbowl discussions. If your class is tackling a case study in small groups, create a second set of small groups with a representative from each of the case study groups so that the groups can share their learning.

4 Tips for Setting Up a Case Study

1. Identify a problem to investigate: This should be something accessible and relevant to students’ lives. The problem should also be challenging and complex enough to yield multiple solutions with many layers.

2. Give context: Think of this step as a movie preview or book summary. Hook the learners to help them understand just enough about the problem to want to learn more.

3. Have a clear rubric: Giving structure to your definition of quality group work and products will lead to stronger end products. You may be able to have your learners help build these definitions.

4. Provide structures for presenting solutions: The amount of scaffolding you build in depends on your students’ skill level and development. A case study product can be something like several pieces of evidence of students collaborating to solve the case study, and ultimately presenting their solution with a detailed slide deck or an essay—you can scaffold this by providing specified headings for the sections of the essay.

Problem-Based Teaching Resources

There are many high-quality, peer-reviewed resources that are open source and easily accessible online.

• The National Center for Case Study Teaching in Science at the University at Buffalo built an online collection of more than 800 cases that cover topics ranging from biochemistry to economics. There are resources for middle and high school students.
• Models of Excellence , a project maintained by EL Education and the Harvard Graduate School of Education, has examples of great problem- and project-based tasks—and corresponding exemplary student work—for grades pre-K to 12.
• The Interdisciplinary Journal of Problem-Based Learning at Purdue University is an open-source journal that publishes examples of problem-based learning in K–12 and post-secondary classrooms.
• The Tech Edvocate has a list of websites and tools related to problem-based learning.

In their book Problems as Possibilities , Linda Torp and Sara Sage write that at the elementary school level, students particularly appreciate how they feel that they are taken seriously when solving case studies. At the middle school level, “researchers stress the importance of relating middle school curriculum to issues of student concern and interest.” And high schoolers, they write, find the case study method “beneficial in preparing them for their future.”

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Early childhood case studies

Our case studies showcase successful early childhood education and care initiatives.

From the Ground Up leadership program inspires early learning educators.

Traineeships a winner for the early childhood workforce.

Tasmanian program gives taste of life working in early childhood education and care.

Stronger local communities by linking support services through playgroups

Eager to Learn: Educating Our Preschoolers (2001)

Chapter: 9&#9;findings, conclusions, and recommendations, 9 findings, conclusions, and recommendations.

T HE RESEARCH ON EARLY CHILDHOOD learning and program effectiveness reviewed in this report provides some very powerful findings:

Young children are capable of understanding and actively building knowledge, and they are highly inclined to do so. While there are developmental constraints on children’s competence, those constraints serve as a ceiling below which there is enormous room for variation in growth, skill acquisition, and understanding.

Development is dependent on and responsive to experience, allowing children to grow far more quickly in domains in which a rich experiential base and guided exposure to complex thinking are available than in those where they receive no such support. Environment—including cultural context—exerts a large influence on both cognitive and emotional development. Genetic endowment is far more responsive to experience than was once thought. Rapid growth of the brain in the early years provides an opportunity for the environment to influence the physiology of development.

Education and care in the early years are two sides of the same coin. Research suggests that secure attachment improves

both social competence and the ability to exploit learning opportunities.

Furthermore, research on early childhood curricula and pedagogy has implications for how early childhood programs can effectively promote development:

Cognitive, social-emotional (mental health), and physical development are complementary, mutually supportive areas of growth all requiring active attention in the preschool years. Social skills and physical dexterity influence cognitive development, just as cognition plays a role in children’s social understanding and motor competence. All are therefore related to early learning and later academic achievement and are necessary domains of early childhood pedagogy.

Responsive interpersonal relationships with teachers nur ture young children’s dispositions to learn and their emerging abilities. Social competence and school achievement are influenced by the quality of early teacher-child relationships, and by teachers’ attentiveness to how the child approaches learning.

While no single curriculum or pedagogical approach can be identified as best, children who attend well-planned, high- quality early childhood programs in which curriculum aims are specified and integrated across domains tend to learn more and are better prepared to master the complex demands of formal schooling. Particular findings of relevance in this regard include the following:

Children who have a broad base of experience in domain-specific knowledge (for example, in mathematics or an area of science) move more rapidly in acquiring more complex skills

More extensive language development—such as a rich vocabulary and listening comprehension—is related to early literacy learning.

Children are better prepared for school when early childhood programs expose them to a variety of classroom structures, thought processes, and discourse patterns. This does not mean adopting the methods and curriculum of the elementary school; rather it is a matter of providing children with a mix of whole

class, small group, and individual interactions with teachers, the experience of different kinds of discourse patterns, and such mental strategies as categorizing, memorizing, reasoning, and metacognition.

While the committee does not endorse any particular cur riculum, the cognitive science literature suggests principles of learning that should be incorporated into any curriculum:

Teaching and learning will be most effective if they engage and build on children’s existing understandings.

Key concepts involved in each domain of preschool learning (e.g., representational systems in early literacy, the concept of quantity in mathematics, causation in the physical world) must go hand in hand with information and skill acquisition (e.g., identifying numbers and letters and acquiring information about the natural world).

Metacognitive skill development allows children to solve problems more effectively. Curricula that encourage children to reflect, predict, question, and hypothesize (examples: How many will there be after two numbers are added? What happens next in the story? Will it sink or float?) set them on course for effective, engaged learning.

young children who are living in circumstances that place them at greater risk of school failure—including poverty, low level of maternal education, maternal depression, and other fac tors that can limit their access to opportunities and resources that enhance learning and development—are much more likely to succeed in school if they attend well-planned, high-quality early childhood programs. Many children, especially those in low-income households, are served in child care programs of such low quality that learning and development are not enhanced and may even be jeopardized.

The importance of teacher responsiveness to children’s differences, knowledge of children’s learning processes and capabilities, and the multiple developmental goals that a quality pre-

school program must address simultaneously all point to the centrality of teacher education and preparation.

The professional development of teachers is related to the quality of early childhood programs, and program quality pre dicts developmental outcomes for children. Formal early childhood education and training has been linked consistently to positive caregiver behaviors. The strongest relationship is found between the number of years of education and training and the appropriateness of a teacher’s classroom behavior.

Programs found to be highly effective in the United States and exemplary programs abroad actively engage teachers and provide high-quality supervision. Teachers are trained and encouraged to reflect on their practice and on the responsiveness of their children to classroom activities, and to revise and plan their teaching accordingly.

Both class size and adult-child ratios are correlated with greater program effects. Low ratios of children to adults are associated with more extensive teacher-child interaction, more individualization, and less restrictive and controlling teacher behavior. Smaller group size has been associated with more child initiations, more opportunities for teachers to work on extending language, mediating children’s social interactions, and encouraging and supporting exploration and problem solving.

CONCLUSIONS AND RECOMMENDATIONS

What is now known about the potential of the early years, and of the promise of high-quality preschool programs to help realize that potential for all children, stands in stark contrast to practice in many—perhaps most—early childhood settings. How can we bring what we know to bear on what we do?

A committee of the National Research Council recently addressed that question with regard to K-12 education (National Research Council, 1999). While the focus of this report differs from theirs, the conceptual framework for using research knowledge to influence educational practice applies. In this model, the impact of research knowledge on classroom practice—the ultimate goal—is mediated through four arenas, as depicted in Fig-

FIGURE 9–1 Arenas through which research knowledge influences classroom practice.

ure 9–1 . When teachers are directly engaged in using research-based programs or curricula, the effect can be direct. This is the case in some model programs. But if research knowledge is to be used systematically in early childhood education and care programs, preservice and in-service education that effectively transmits that knowledge to those who staff the programs will be required.

While we have argued that the teacher is central, effective teachers work with curricula and teaching materials. In Chapter 5 we refer to exemplary curricula that incorporate research knowledge. Changing practice requires that teachers know about, and have access to, a store of teaching materials.

Quality preschool programs can be encouraged or thwarted by public policy. Regulations and standards can incorporate research knowledge to put a floor under program quality. Public funding and the rules that shape its availability can encourage quality above that floor, and can ensure accessibility to those most in need. And finally, program administrators and teachers, as well as policy makers, are ultimately accountable to parents and to the

public. Parents’ expectations of, and support for, preschool programs, as well as their participation in activities that support early development, can contribute to program success.

The chance of effectively changing early childhood education will increase if the four arenas that influence practice are addressed simultaneously and in a mutually supportive fashion. The committee’s recommendations address each of these four arenas of influence.

Professional Development

At the heart of the effort to promote quality preschool, from the committee’s perspective, is a substantial investment in the education and training of preschool teachers.

Recommendation 1: Each group of children in an early childhood education and care program should be assigned a teacher who has a bachelor’s degree with specialized education related to early childhood (e.g., developmental psychology, early childhood education, early childhood special education). Achieving this goal will require a significant public investment in the professional development of current and new teachers.

Sadly, there is a great disjunction between what is optimal pedagogically for children’s learning and development and the level of preparation that currently typifies early childhood educators. Progress toward a high-quality teaching force will require substantial public and private support and incentive systems, including innovative educational programs, scholarship and loan programs, and compensation commensurate with the expectations of college graduates.

Recommendation 2: Education programs for teachers should provide them with a stronger and more specific foundational knowledge of the development of children’s social and affective behavior, thinking, and language.

Few programs currently do. This foundation should be linked to teachers’ knowledge of mathematics, science, linguistics, literature, etc., as well as to instructional practices for young children.

Recommendation 3: Teacher education programs should require mastery of information on the pedagogy of teaching preschool-aged children, including:

Knowledge of teaching and learning and child development and how to integrate them into practice.

Information about how to provide rich conceptual experiences that promote growth in specific content areas, as well as particular areas of development, such as language (vocabulary) and cognition (reasoning).

Knowledge of effective teaching strategies, including organizing the environment and routines so as to promote activities that build social-emotional relationships in the classroom.

Knowledge of subject-matter content appropriate for preschool children and knowledge of professional standards in specific content areas.

Knowledge of assessment procedures (observation/performance records, work sampling, interview methods) that can be used to inform instruction.

Knowledge of the variability among children, in terms of teaching methods and strategies that may be required, including teaching children who do not speak English, children from various economic and regional contexts, and children with identified disabilities.

Ability to work with teams of professionals.

Appreciation of the parents’ role and knowledge of methods of collaboration with parents and families.

Appreciation of the need for appropriate strategies for accountability.

Recommendation 4: A critical component of preservice preparation should be a supervised, relevant student teaching or internship experience in which new teachers receive ongoing guidance and feedback from a qualified supervisor.

There are a number of models (e.g., National Council for Accreditation of Teacher Education) that suggest the value of this sort of supervised student teaching experience. A principal goal of this experience should be to develop the student teacher’s ability to integrate and apply the knowledge base in practice. Col-

laborative support by the teacher preparation institution and the field placement is essential. Supervision of this experience should be shared by a master teacher and a regular or clinical university faculty member.

Recommendation 5: All early childhood education and child care programs should have access to a qualified supervisor of early childhood education.

Teachers should be provided with opportunities to reflect on practice with qualified supervisors. This supervisor should be both an expert teacher of young children and an expert teacher mentor. Such supervisors are needed to provide in-service collaborative experiences, in-service materials (including interactive videodisc materials), and professional development opportunities directed toward improvement of early childhood pedagogy.

Recommendation 6: Federal and state departments of education, human services, and other agencies interested in young children and their families should initiate programs of research and development aimed at learning more about effective preparation of early childhood teachers.

Of particular concern are strategies directed toward bringing experienced early childhood educators, such as child care providers and prekindergarten and Head Start teachers, into compliance with standards for higher education and certification. Such programs should ensure that the field takes full advantage of the knowledge and expertise of existing staff and builds on diversity and strong community bonds represented in the current early childhood care and education work force. At the same time, it should assure that the fields of study described above are mastered by those in the existing workforce. These programs should include development of materials for early childhood professional education. Material development should entail cycles of field testing and revision to assure effectiveness.

Recommendation 7: The committee recommends the development of demonstration schools for professional development.

Many people, including professional educators of older chil-

dren, do not know what an early childhood program should look like, what should be taught, or the kind of pedagogical strategies that are most effective. Demonstration schools would provide contextual understanding of these issues.

The Department of Education should collaborate with universities in developing the demonstration schools and in using them as sites for ongoing research:

on the efficacy of various models, including pairing demonstration schools in partnership with community programs, and pairing researchers and in-service teachers with exemplary community-based programs;

to identify conditions under which the gains of mentoring, placement of pre-service teachers in demonstration schools, and supervised student teaching can be sustained once teachers move into community-based programs.

Educational Materials

Good teachers must be equipped with good curricula. The content of early childhood curricula should be organized systematically into a coherent program with overarching objectives integrated across content and developmental areas. They should include multiple activities, such as systematic exploration and representation, planning and problem solving, creative expression, oral expression, and the ability and willingness to listen to and incorporate information presented by a teacher, sociodramatic and exercise play, and arts activities.

Important curriculum areas are often omitted from early education programs, although there is research to support their inclusion (provided they are addressed in an appropriate manner). Methods of scientific investigation, number concepts, phonological awareness, cultural knowledge, languages, and computer technology all fall into this category.

Because children differ in so many respects, teaching strategies used with any curriculum, from the committee’s perspective, need to be flexibly adapted to meet the specific needs and prior knowledge and understanding of individual children. Embedded in the curriculum should be opportunities to assess children’s

prior understanding and mastery of the skills and knowledge being taught.

Teachers will also need to provide different levels of instruction in activities and use a range of techniques, including direct instruction, scaffolding, indirect instruction (taking advantage of moments of opportunity), and opportunities for children to learn on their own (self-directed learning). The committee believes it is particularly important to maintain children’s enthusiasm for learning by integrating their self-directed interests with the teacher-directed curriculum.

Recommendation 8: The committee recommends that the U.S. Department of Education, the U.S. Department of Health and Human Services, and their equivalents at the state level fund efforts to develop, design, field test, and evaluate curricula that incorporate what is known about learning and thinking in the early years, with companion assessment tools and teacher guides.

Each curriculum should emphasize what is known from research about children’s thinking and learning in the area it addresses. Activities should be included that enable children with different learning styles and strengths to learn.

Each curriculum should include a companion guide for teachers that explains the teaching goals, alerts the teacher to common misconceptions, and suggests ways in which the curriculum can be used flexibly for students at different developmental levels. In the teacher’s guide, the description of methods of assessment should be linked to instructional planning so that the information acquired in the process of assessment can be used as a basis for making pedagogical decisions at the level of both the group and the individual child.

Recommendation 9: The committee recommends that the U.S. Department of Education and the U.S. Department of Health and Human Services support the use of effective technology, including videodiscs for preschool teachers and Internet communication groups.

The process of early childhood education is one in which interaction between the adult/teacher and the child/student is the

most critical feature. Opportunities to see curriculum and pedagogy in action are likely to promote understanding of complexity and nuance not easily communicated in the written word. Internet communication groups could provide information on curricula, results of field tests, and opportunities for teachers using a common curriculum to discuss experiences, query each other, and share ideas.

States can play a significant role in promoting program quality with respect to both teacher preparation and curriculum and pedagogy.

Recommendation 10: All states should develop program standards for early childhood programs and monitor their implementation. These standards should recognize the variability in the development of young children and adapt kindergarten and primary programs, as well as preschool programs, to this diversity. This means, for instance, that kindergartens must be readied for children. In some schools, this will require smaller class sizes and professional development for teachers and administrators regarding appropriate teaching practice, so that teachers can meet the needs of individual children, rather than teaching to the “average” child. The standards should outline essential components and should include, but not be limited to, the following categories:

School-home relationships;

Class size and teacher-student ratios;

Specification of pedagogical goals, content, and methods;

Assessment for instructional improvement;

Educational requirements for early childhood educators; and

Monitoring quality/external accountability.

Recommendation 11: Because research has identified content that is appropriate and important for inclusion in early childhood programs, content standards should be developed

and evaluated regularly to ascertain whether they adhere to current scientific understanding of children’s learning.

The content standards should ensure that children have access to rich and varied opportunities to learn in areas that are now omitted from many curricula—such as phonological awareness, number concepts, methods of scientific investigation, cultural knowledge, and language.

Recommendation 12: A single career ladder for early childhood teachers, with differentiated pay levels, should be specified by each state.

This career ladder should include, at a minimum, teaching assistants (with child development associate certification), teachers (with bachelor’s degrees), and supervisors.

Recommendation 13: The committee recommends that the federal government fund well-planned, high-quality center-based preschool programs for all children at high risk of school failure.

Such programs can prevent school failure and significantly enhance learning and development in ways that benefit the entire society.

Policies that support the provision of quality preschool on a broad scale are unlikely without widespread public support. To engender that support, it is important for the public to understand both the potential of the preschool years, and the quality of programming required to realize that potential.

Recommendation 14: Organizations and government bodies concerned with the education of young children should actively promote public understanding of early childhood education and care.

Beliefs that are at odds with scientific understanding—that maturation automatically accounts for learning, for example, or that children can learn concrete skills only through drill and practice—must be challenged. Systematic and widespread public

education should be undertaken to increase public awareness of the importance of providing stimulating educational experiences in the lives of all young children. The message that the quality of children’s relationships with adult teachers and child care providers is critical in preparation for elementary school should be featured prominently in communication efforts. Parents and other caregivers, as well as the public, should be the targets of such efforts.

Recommendation 15: Early childhood programs and centers should build alliances with parents to cultivate complementary and mutually reinforcing environments for young children at home and at the center.

FUTURE RESEARCH NEEDS

Research on early learning, child development, and education can and has influenced the development of early childhood curriculum and pedagogy. But the influences are mutual. By evaluating outcomes of early childhood programs we have come to understand more about children’s development and capacities. The committee believes that continued research efforts along both these lines can expand understanding of early childhood education and care, and the ability to influence them for the better.

Research on Early Childhood Learning and Development

Although it is apparent that early experiences affect later ones, there are a number of important developmental questions to be studied regarding how, when, and which early experiences support development and learning.

Recommendation 16: The committee recommends a broad empirical research program to better understand:

The range of inputs that can contribute to supporting environments that nurture young children’s eagerness to learn;

Development of children’s capacities in the variety of cog-

nitive and socioemotional areas of importance in the preschool years, and the contexts that enhance that development;

The components of adult-child relationships that enhance the child’s development during the preschool years, and experiences affecting that development for good or for ill;

Variation in brain development, and its implications for sensory processing, attention, and regulation;

The implications of developmental disabilities for learning and development and effective approaches for working with children who have disabilities;

With regard to children whose home language is not English, the age and level of native language mastery that is desirable before a second language is introduced and the trajectory of second language development.

Research on Programs and Curricula

Recommendation 17: The next generation of research must examine more rigorously the characteristics of programs that produce beneficial outcomes for all children. In addition, research is needed on how programs can provide more helpful structures, curricula, and methods for children at high risk of educational difficulties, including children from low-income homes and communities, children whose home language is not English, and children with developmental and learning disabilities.

Much of the program research has focused on economically disadvantaged children because they were the targets of early childhood intervention efforts. But as child care becomes more widespread, it becomes more important to understand the components of early childhood education that have developmental benefits for all children.

With respect to disadvantaged children, we know that quality intervention programs are effective, but better understanding the features that make them effective will facilitate replication on a large scale. The Abecedarian program, for example, shows many developmental gains for the children who participate. But in addition to the educational activities, there is a health and nutrition component. And child care workers are paid at a level

comparable to local public school teachers, with a consequent low turnover rate in staff. Whether the program effect is caused by the education component, the health component, or stability of caregiver, or some necessary combination of the three, is not possible to assess. Research on programs for this population should pay careful attention to home-school partnerships and their effect, since this is an aspect of the programs that research suggests is important.

Research on programs for any population of children should examine such program variations as age groupings, adult-child ratios, curricula, class size, looping, and program duration. These questions can best be answered through random assignment, longitudinal studies. Such studies raise concerns because some children receive better services than others, and because they are expensive. However, random assignment between programs that have very similar quality features, but vary on a single dimension (a math curriculum, for example, or class size) would seem less controversial. The cost of conducting such research must, of course, be weighed against the benefits. Given the dramatic expansion in the hours that children spend in out-of-home care in the preschool years, new knowledge can have a very high payoff.

Research is also needed on the interplay between an individual child’s characteristics, the immediate contexts of the home and classroom, and the larger contexts of the formal school environment in developing and assessing curricula. An important line of research is emerging in this area and needs continued support.

Recommendation 18: A broad program of research and development should be undertaken to advance the state of the art of assessment in three areas: (1) classroom-based assessment to support learning (including studies of the impact of methods of instructional assessment on pedagogical technique and children’s learning), (2) assessment for diagnostic purposes, and (3) assessment of program quality for accountability and other reasons of public policy.

All assessments, and particularly assessments for accountability, must be used carefully and appropriately if they are to resolve, and not create, educational problems. Assessment of young

children poses greater challenges than people generally realize. The first five years of life are a time of incredible growth and learning, but the course of development is uneven and sporadic. The status of a child’s development as of any given day can change very rapidly. Consequently assessment results—in particular, standardized test scores that reflect a given point in time— can easily misrepresent children’s learning.

Assessment itself is in a state of flux. There is widespread dissatisfaction with traditional norm-referenced standardized tests, which are based on early 20th century psychological theory. There are a number of promising new approaches to assessment, among them variations on the clinical interview and performance assessment, but the field must be described as emergent. Much more research and development are needed for a productive fusion of assessment and instruction to occur and if the potential benefits of assessment for accountability are to be fully realized.

Research on Ways to Create Universal High Quality

The growing consensus regarding the importance of early education stands in stark contrast to the disparate system of care and education available to children in the United States in the preschool years. America’s programs for preschoolers vary widely in quality, content, organization, sponsorship, source of funding, relationship to the public schools, and government regulation.

As the nation moves toward voluntary universal early childhood programs, parents, and public officials face important policy choices, choices that should be informed by careful research.

Recommendation 19: Research to fully develop and evaluate alternatives for organizing, regulating, supporting, and financing early childhood programs should be conducted to provide an empirical base for the decisions being made.

Compare the effects of program variations on short-term and long-term outcomes, including studies of inclusion of children with disabilities and auspices of program regulation.

Examine preschool administration at local, county, and state levels to assess the relative quality of the administrative and support systems now in place.

Consider quality, infrastructure, and cost-effectiveness.

Review the evidence that should inform state standards and licensing, including limits on group size and square footage requirements.

Develop instruments and strategies to monitor the achievement of young children that meet state and national accountability requirements, respect young children’s unique learning and developmental needs, and do not interfere with teachers’ instructional decision making.

At a time when the importance of education to individual fulfillment and economic success has focused attention on the need to better prepare children for academic achievement, the research literature suggests ways to make gains toward that end. Parents are relying on child care and preschool programs in ever larger numbers. We know that the quality of the programs in which they leave their children matters. If there is a single critical component to quality, it rests in the relationship between the child and the teacher/caregiver, and in the ability of the adult to be responsive to the child. But responsiveness extends in many directions: to the child’s cognitive, social, emotional, and physical characteristics and development.

Much research still needs to be done. But from the committee’s perspective, the case for a substantial investment in a high-quality system of child care and preschool on the basis of what is already known is persuasive. Moreover, the considerable lead by other developed countries in the provision of quality preschool programs suggests that it can, indeed, be done on a large scale.

Clearly babies come into the world remarkably receptive to its wonders. Their alertness to sights, sounds, and even abstract concepts makes them inquisitive explorers—and learners—every waking minute. Well before formal schooling begins, children's early experiences lay the foundations for their later social behavior, emotional regulation, and literacy. Yet, for a variety of reasons, far too little attention is given to the quality of these crucial years. Outmoded theories, outdated facts, and undersized budgets all play a part in the uneven quality of early childhood programs throughout our country.

What will it take to provide better early education and care for our children between the ages of two and five? Eager to Learn explores this crucial question, synthesizing the newest research findings on how young children learn and the impact of early learning. Key discoveries in how young children learn are reviewed in language accessible to parents as well as educators: findings about the interplay of biology and environment, variations in learning among individuals and children from different social and economic groups, and the importance of health, safety, nutrition and interpersonal warmth to early learning. Perhaps most significant, the book documents how very early in life learning really begins. Valuable conclusions and recommendations are presented in the areas of the teacher-child relationship, the organization and content of curriculum, meeting the needs of those children most at risk of school failure, teacher preparation, assessment of teaching and learning, and more. The book discusses:

• Evidence for competing theories, models, and approaches in the field and a hard look at some day-to-day practices and activities generally used in preschool.
• The role of the teacher, the importance of peer interactions, and other relationships in the child's life.
• Learning needs of minority children, children with disabilities, and other special groups.
• Approaches to assessing young children's learning for the purposes of policy decisions, diagnosis of educational difficulties, and instructional planning.
• Preparation and continuing development of teachers.

Eager to Learn presents a comprehensive, coherent picture of early childhood learning, along with a clear path toward improving this important stage of life for all children.

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Entering Kindergarten After Years of Play: A Cross-Case Analysis of School Readiness Following Play-Based Education

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• Published: 15 November 2022
• Volume 52 , pages 167–179, ( 2024 )

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• Lisa Fyffe   ORCID: orcid.org/0000-0003-4073-2137 1 ,
• Pat L. Sample 1 ,
• Angela Lewis 2 ,
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Cross-case study research was used to explore the school readiness of four 5-year-old children entering kindergarten during the 2020–2021 school year after three or more years of play-based early childhood education at a Reggio Emilia-inspired early childhood education center. Data included a series of three 1-h individual interviews with four mothers and three kindergarten teachers, field visits during remote learning, and artifact collection over the course of the school year. Themes describing the children’s school readiness were developed through cross-case analysis. Participants described the children as learners, explorers, communicators, and empathizers. The learner theme centers on the children’s responsiveness to instruction; the explorer theme describes how the children approached learning; the communicator theme illustrates the children’s prowess with social connection and self-advocacy, and the empathizer theme shows the thoughtfulness and emotional sensitivity these children displayed. Findings suggest that play-based learning prepared these children for successful kindergarten experiences and was a viable early childhood education pedagogy fostering school readiness.

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Introduction

School readiness is a culmination of a lifetime of experiences that prepare children to enter a group learning context where they must modify their actions in response to feedback, establish relationships with peers and adults, and apply new knowledge within a variety of learning contexts. Thus, children benefit from formal education when they have developed processes that support learning, such as establishing social relationships, self-management, and positive approaches to learning (Eggum-Wilkins et al., 2014 ; Ginsburg, 2007 ; Pistorova & Slutsky, 2018 ).

The National Association for the Education of Young Children (NAEYC, 2017 ) promotes the use of play as an educational pedagogy during early childhood to facilitate the social adaptation, inquisitiveness, and self-regulation necessary for comprehending academic content and general knowledge. NAEYC ( 2017 ) described play in early childhood education as “a valuable pedagogical tool in that it features the precise contexts that facilitate learning… mental activation, engagement, social interaction, and meaningful connections” (p. 3). Play has been considered the foundation of children’s learning dating back to the days of Plato (427–347 BC) and Aristotle (387–322 BC), both of whom wrote about the virtues of play as necessary to develop children into competent adults. Vygotsky ( 1978 ) described that exploring culturally instilled roles through play developed attention, memory, abstract thought, and self-monitoring. Elkonin ( 1978 ) extended this discussion by saying that play fostered children’s mental representation, motivation and intentionality, awareness of multiple perspectives, behavior modification in accordance with social norms, and promotes internal morality as children create, follow, adapt, and enforce rules.

More recently, the American Academy of Pediatrics (Ginsburg, 2007 ) described play as “essential to the cognitive, physical, social and emotional well-being of children and youth” and called for “the inclusion of play as we... prepare our children to be academically, socially, and emotionally equipped to lead us into the future” (p. 183). Zosh et al. ( 2017 ) concurred, stating that “content only serves children as far as they can apply and build on it… children also need a deep conceptual understanding to connect concepts and skills, apply knowledge and spark new ideas” (p. 5). Given that play fosters the social reciprocity, self-management and creative thought processes deemed necessary for school readiness, time spent playing provides essential preparation for learning receptivity and responsiveness.

Consistent with these views, early childhood education programs have been historically grounded in child-directed play experiences with a primary focus on developing social relationships, approaches to learning, and self-regulation (Burchinal et al., 2008 ). Play as the focus of early childhood education remained essentially unchallenged in the United States until 1983, when the National Commission on Excellence in Education issued a report entitled A Nation at Risk: The Imperative for Education Reform . This Presidential-commissioned report described education in the United States as “a rising tide of mediocrity” citing American children’s poor academic performance, rampant illiteracy among adults and teens and declining scores on standardized achievement tests measuring academic competency. The authors recommended sweeping educational reforms with higher expectations of student performance and rising academic achievement test scores as the cornerstone of a stronger American education system (National Commission on Excellence in Education, 1983 ). Congress responded by enacting educational reforms, beginning with America First (1991), a comprehensive education reform act aimed at improving school readiness.

America First defined school readiness along five domains: physical health and wellbeing, social-emotional development, language development, general knowledge and cognition, and approaches to learning. Most states evaluated school readiness by measuring general knowledge and cognition, placing less focus on the other four domains. Subsequent educational reform legislation, No Child Left Behind (NCLB; 2002) and Race to the Top-Early Learning Challenge (RTTT-ELC; 2013), further cemented administration of standardized assessments prior to kindergarten entry. This represented a substantial shift from formative assessments of early childhood education, where teachers evaluated children over time (Hustedt et al., 2018 ).

As early childhood educators navigated increasing pressures for proficiency in early literacy and numeracy, the content of many early childhood education programs emphasized academic content (Fleer, 2021 ; Nicolopoulou, 2010 ; Taylor & Boyer, 2019 ). However, academic instruction in preschool is controversial; some early childhood educators have expressed concern about the developmental appropriateness of direct instruction practices (NAEYC, 2017 ; Zosh et al., 2017 ). This philosophical split left some early childhood programs grounded in play-based, child-directed experiential learning while others emphasized direct academic instruction. Durkin et al. ( 2022 ) stated that direct instruction in early childhood education produces short-term gains in constrained literacy skills (e.g., recognizing the alphabet), but not the unconstrained literacy and numeracy skills associated with long-term academic success (e.g., comprehension, problem-solving). This suggests that content-heavy preschool curricula most aligned with school readiness assessments may fail to capture the foundational aptitudes children need for academic achievement.

School readiness is a complicated and nuanced concept; children need more than general knowledge and academic skills to thrive at school. Hustedt et al. ( 2018 ) found that kindergarten teachers favored non-academic skills as most valuable: caring for personal needs, exhibiting self-control, communicating needs and preferences, modifying behavior and interacting cooperatively. Pistorova and Stutsky (2018) further argued that the twenty-first century learner must be fluent with “critical thinking, communication, collaboration and creativity” (p. 495); these are learned through capitalizing on children’s natural curiosity and inquisitiveness. Zosh et al. ( 2017 ) stated that optimal learning occurs within a playful context where children experience joyfulness through engagement in meaningful activities. Play-based learning allows children to develop and test theories and make new discoveries, thus expanding their capacity for problem-solving and construction of higher-order conceptual schemas (Fleer, 2021 ; Sim & Xu, 2017 ). Finally, peer play and social relationships have been associated with higher levels of global teacher-rated kindergarten competence including following directions, academic receptivity, self-regulation, and cooperative interactions (Eggum-Wilkins et al., 2014 ).

Johansson and Samuelsson (2006) argued that play and learning in young children are integrated, and researchers must seek to understand the relationship between play and learning rather than dichotomize them with false distinctions. Nilsson et al. ( 2018 ) advocated for a play-as-learning approach to early childhood education, where learning “is not just understood in the narrow cognitive sense…but more broadly as transformations driven by different kinds of experiences that lead to sustained change” (p. 232). This suggests a need for research aimed at explicating the ways in which play contributes to readiness for formal education. Therefore, the purpose of this paper is to describe how teachers and parents interpreted the school readiness of four children as they navigated kindergarten after three or more years of play-based early childhood education at a Reggio Emilia-inspired school.

This manuscript is part of a larger, longitudinal study exploring how children fared as kindergarteners following play-based early childhood education, in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupation and Rehabilitation Science at Colorado State University for first author LF. Data were collected from September 2020 through May 2021. This study was approved through the Colorado State University Institutional Review Board (approval 19-9519H).

Research Design

We used Yin’s ( 2018 ) cross-case study approach to synthesize findings from the cases. We collected data at the onset, midpoint, and conclusion of the kindergarten year. Each data cache informed subsequent data collection.

Participants

We recruited participants from a Reggio Emilia-inspired play-based early childhood center in Northern Colorado. Reggio Emilia is a highly regarded approach to early childhood education where children collaborate with their teachers to explore their interests through projects which are thoughtfully designed and documented (McNally & Slutsky, 2017 ). We enrolled four participant clusters in the summer preceding the child’s kindergarten enrollment; each cluster ideally included a parent and a kindergarten teacher associated with an individual child. Mothers were the parent informant for all four clusters and provided contact information for their child’s kindergarten teacher. Three of four kindergarten teachers participated; one declined due to concerns with the COVID-19 pandemic-affected school year.

Kindergarten teachers represented three different curricular foci: Core Knowledge, International Baccalaureate. and Science, Technology, Engineering and Math (STEM). The research team deemed dissimilar kindergarten foci desirable to offer variation in kindergarten experience, but this was not a participant requirement. Table 1 contains a description of cluster members organized by child.

Pandemic Influence

Public health orders related to the COVID-19 pandemic affected the kindergarten year. Over half of the kindergarten year occurred through remote learning and all in-person school days were affected by public health orders. Requirements of face masks, social distancing, and isolated classroom cohorts limited participation in specials, lunchroom, recess, and group learning experiences. Teacher participants described challenges translating learning activities to remote platforms, altering the scope and sequence of the curriculum, and emotional and behavioral challenges engaging students during in-person learning.

Public health orders also altered data collection as visitors were not allowed in public schools. We adapted to these restrictions by completing home visits during remote learning days, requesting work samples and test scores from participants, and using video conferencing for most interviews.

We used semi-structured interviews with participants as the primary data source. Each participant completed three in-depth semi-structured interviews lasting approximately one hour per encounter. The interviews coincided with the start of the school year and planned instructional format shifts. We recorded all interviews; a professional service transcribed them verbatim. See Fig.  1 for an illustration of the timing of interviews alongside of the start and end of the school year and district-wide instructional shifts.

Timeline of public health orders related to COVID-19, district-wide instructional format shifts, and participant interview schedule

We developed separate but parallel interview protocols for the participant groups prior to each interview. Some questions were written for both groups; others were written only for parents or teachers. We wanted to capitalize on each participant’s unique vantage point, while allowing for comparisons of perspectives within and across cases. For example, we asked both parents and teachers about the child’s school readiness based on Colorado’s early learning standards. We asked teachers to describe how the child fit within their classroom expectations and parents to describe how their child had grown over the course of the school year. See Table 2 for interview protocol examples.

In the case of the child whose teacher did not participate (Nadine), we used the same parent interview protocol with her mother as we did with the other parent participants. Nadine’s mother provided work samples and school-generated reports. We blended Nadine’s data within the cross-case analysis as appropriate, acknowledging that we had half the data for her as other participants.

Data Analysis

Congruent with Yin’s ( 2018 ) case-based approach, we analyzed each participant interview upon its conclusion and merged the interviews by case to complete the initial within-case analysis. Once we identified themes from an individual case, we looked for replication across cases, remaining sensitive to congruences and differences as we identified patterns. By comparing patterns across cases, we constructed common themes.

Within-Case Analysis

In the initial phase of analysis, first author LF read each transcript multiple times for familiarity, documented any reactions and biases, and listed all topics emphasized by the participants for each case. In the second phase, these preliminary topics provided an organizational structure for grouping the data into conceptual clusters. In the third phase, authors LF, PS and AB systematically worked through groupings and developed initial codes with extrapolated, verbatim text illustrating the themes under consideration. In the fourth phase, author LF defined and described the themes from the individual cases and selected representative quotes for illustration.

Cross-Case Analysis

Cross-case analysis occurred after individual case analyses. First, author LF reduced the data set to focus on the most significant conceptual clusters; these became axial codes linking the data across cases. For this manuscript, school readiness was the axial code of interest (kindergarten performance and adaptation were the other axial codes and will be the foci of subsequent papers). In the second phase, author LF operationalized school readiness into a probing question ( How are parents and teachers describing the school readiness of these children? ), which guided the cross-case analysis. Finally, authors LF, PS and AB constructed cross-case themes using inductive coding to extrapolate the major descriptors of school readiness common to all cases. First author LF served as the primary coder, PS was the second coder and both PS and AB engaged in ongoing conversations with LF to define, clarify, and construct the final themes. These themes were then presented to the entire research team for discussion until consensus was reached. See Fig.  2 for a graphic illustrating this process.

Explorer theme construction: within-case analysis to cross-case analysis

Quality Assurance

We took many steps to safeguard the quality of the study data, as well as the data analysis. We remained engaged with participants for a full academic year which allowed for data triangulation and opportunities for member checking. We practiced highly disciplined subjectivity through data trail audits, explicit links between interpretation and participant excerpts, and constant comparative analysis within and across cases (Yin, 2018 ). We held recurring meetings to discuss the findings and arrive at consensus with all members of the research team.

Positionality

Author LF supervised occupational therapy students completing internships at the play-based early childhood center where the children were enrolled prior to entering kindergarten. Author PS has expertise in qualitative research methodology but had not worked with early childhood research prior to this study. Author AL is an early childhood education teacher educator and coached teacher candidates at the research site. Author KR was the Executive Director of the center during the time when this study occurred. Author AB is an expert in play and has many years of school-based experience as an occupational therapist and researcher.

Participants believed the children were well prepared for kindergarten. Four themes were identified through the data analysis process that illustrate their school readiness: learners, explorers, communicators, and empathizers . See Table 3 for full definitions of each theme.

Theme 1: Learners

We defined learner as a child who is highly receptive to acquiring new knowledge. Data within this theme described children’s responses to classroom instruction and teacher feedback. Teachers reported that the children arrived at kindergarten ready to learn and were quick to integrate new knowledge and concepts. They noted well-developed language, eagerness for learning, and willingness to embrace feedback and challenge. Isaac’s teacher described him by stating.

What I could tell is that he was ready to learn. He was really engaged with letters and numbers, and he was eager. It was the perfect time to start teaching him how to read and write… (Isaac, 3rd Teacher Interview, p. 13)

Addy’s teacher described her by saying.

She knew about half of her letter names and sounds, and that's actually a little ahead of the game for a lot of kiddos coming into kindergarten. She has a good sense of what word would make sense when she gets to a word she doesn’t know…it’s like it’s innate with her. So that tells me that she had a very good background in those phonemic awareness skills… (Addy, 3rd Teacher Interview, p. 4)

Teachers described the children as self-directed, which heightened their readiness to retain new information and engage in academics. Leah’s teacher described her, saying, “I feel like [self-direction] is something that she had a strong base on as she started kindergarten. Really inquiring more, and kind of leading herself through explorations, and finding new interests on her own.” (Leah, 3rd Teacher Interview, p. 11). Nadine’s mother described her inquisitiveness by saying “Being able to spark interests in lots of settings was incredibly helpful for her to tackle this year and really thrive” (Nadine. 3rd Parent Interview, p. 14).

Teachers also expressed how the ability to persist through challenge and apply feedback benefitted the children. Leah’s teacher described her by saying:

She understands challenge, and she understands the benefit from challenge. She doesn’t shy away, because she sees how challenge benefits her as a learner and a problem solver. She understands what her job is as a student and wants to do her very best with that. (Leah, 3rd Teacher Interview, p. 12)

Isaac’s teacher described him as a responsive learner who takes feedback and applies teachings in a variety of contexts. “He’s a quick learner. He will apply what I’ve asked him to change and take it in a direction I’d like him to go .” (Isaac, 3rd Teacher Interview, p. 7).

Theme 2: Explorers

While the learner theme centered on how a child reacted to their classroom experiences, the explorer theme centers on how a child approached learning and applied new knowledge. We defined explorer as a child who is inquisitive, creative and takes initiative in seeking and expanding upon their learning experiences. Parents and teachers saw inquisitiveness as a strength of all the children. They shared stories of the children’s creativity and open-mindedness. Nadine’s mother described how she used exploration to follow an interest in the Fibonacci rule of spirals. She drew pictures of the pinecones she found in their backyard, carefully documenting their shape and composition.

I think [varied interests] was probably the biggest one that grew out of [play-based learning] and was incredibly helpful for her being able to tackle this year and really thrive. I think it’s just because it was child-led and because it was thinking about the environment and the teacher, and just being able to spark interests in lots of different settings. You just figure out your own goals and you’re trying to set them yourself. For her, when she set her own goals, she was probably more likely to persevere. And two, I think they give a lot of space for being curious about the world. (Nadine, 3rd Parent Interview, p. 27)

Addy’s mother told a story of how Addy was inspired by a book about Marie Curie and subsequently spent time mixing potions in the bathtub. She felt that play-based learning instilled a curiosity and desire to learn through exploration and discovery in Addy.

So, like I said, “What do you want to do when you grow up?” She said, “I don’t know. I want to be a baker, a scientist.” So, then she decided, when they were out at the store, she wanted a book about Marie Curie so that she could read about a scientist. And we find stuff all the time in the bathroom. She’s putting things together and making potions. But that’s her jam, is doing things. But it’s evidenced by all of her clothing as well, because it’s always got stains, and chalks, and dirt. So, she’s in there. (Addy, 3rd Parent Interview, p. 15)

Isaac’s mother spoke of the connection she observed between exploration, inquisitiveness, and confidence and how this impacted Isaac’s engagement with learning in kindergarten.

Well, I think [play-based learning] provided him some independence and some confidence. And I think it helped him learn by doing, learn through teamwork, learn through curiosity, and asking questions. Because I think he had the opportunity in a play-based environment to pursue his interests and curiosities and sort of direct his learning, I think he probably felt more confident and equipped to ask questions and direct a bit of his learning in the school setting, too. (Isaac, 3rd Parent Interview, p. 6)

Leah’s mother described how play-based learning contributed to Leah’s open-mindedness about the world and her willingness to take initiative with learning.

Because of her play-based background, I really think that she’s been in a place where she’s been able to be that much more open-minded. I think the focus on explorative play has been crucial for learning different ways of perceiving and understanding the world around her and fostering her as an innate learner and leader of her own development. And I think it would have been much more difficult to have had that type of growth in a different type of setting. (Leah, 3rd Parent Interview, p. 9)

Participants also attributed the children’s varied approaches to learning to play-based experiences. Nadine’s mother described how Nadine continued to draw on the creativity fostered through play-based learning in approaching her academics.

She wasn’t coming in just wanting to follow instructions exactly, which I think is a great way to approach learning. Because I know sometimes if you just think about following the steps of something to get the A or something like that, to me it kind of undermines the joy of learning. So, I think for her, she kept that creative approach. (Nadine, 3rd parent Interview, p. 19)

Theme 3: Communicators

We defined communicator as a child who demonstrates self-advocacy, conflict management or relationship-building skills. Data within this category shows how the children expressed themselves and established social connections. Parents and teachers described the children as in-tune with their peer cohorts, well-versed in considering other perspectives and able to describe and advocate for their needs. Teachers noted that social communication was a struggle for many children entering kindergarten during the 2020–2021 school year, but felt these children were effective at establishing social connections and cultivating relationships with peers and adults.

Addy’s teacher spoke about her “Friday Fun’ group where kindergarteners were allowed to free play with vintage toys and art supplies for an hour in the classroom.

This year, she had to remain constantly present during this time because the children were unable to share toys and develop a play schema together. Addy, however, was always able to find something to do and negotiate with others for turn taking and sharing of materials.

I feel like for a kindergartner she came in knowing a lot of the social cues and how to move around a classroom, how to manage listening to directions, but also if something isn’t quite going her way, she’ll either go do something else or say how she feels. I have never heard her, necessarily, argue with someone about something. She seems to handle conflict pretty well, which, I didn’t really teach her that. (Addy, 3rd Teacher Interview, p. 16)

Leah’s mother described how Leah used her negotiation skills to intervene during a potentially challenging situation when Leah and her friends all wanted to play dress-up with the same butterfly cape.

I think that where [play-based learning] was really helpful for her was in learning to speak up for difficult situations. To me, watching her negotiate with those friends how much time each child is going to have with this really great outfit... I think that that has been evident to me that she really does have a way of kind of owning her feelings and stepping up and saying something. It’s just hard to know of course, but I think the skills that she has now, in terms of her confidence, really grew out of negotiating with others in a play-based environment. (Leah, 3rd Parent Interview, p. 10)

Isaac’s mother described how Isaac’s ability to communicate was helpful in navigating the emotions of his kindergarten year.

He used to talk about when he was struggling. He will say, “I’m feeling sad right now, I am feeling upset right now.” He’ll just say it. Sometimes we know it’s coming, and sometimes we didn’t. I think that was a real advantage for this year in particular. (Isaac, 3rd Parent Interview, p. 20)

Leah’s teacher described a scenario where Leah sought out a weekly meeting with the Assistant Principal to discuss life events, which she chose over her recess time.

I have come to understand how important personal connection is for [Leah]. And so, she is amazing with interactions and relationships with kids, but she’s clearly somebody who seeks that connection with other adults. And I talked about her in class just being such a great listener with friends and classmates. But it’s all around. She just has genuine interest in learning from other people’s stories. (Leah, 3rd Teacher Interview, p. 10)

Theme 4: Empathizers

We defined empathizer as a child who expresses compassion towards others, and data within this theme represent how children engaged thoughtfully with their classmates. Teachers especially described scenarios where these children exceeded their expectations for social reciprocity and initiating acts of kindness. Addy’s teacher described Addy by saying, “all the kids at this point have been taught how to be kind but to see a child actually notice a friend who is alone and do something about it is quite remarkable.”

Leah’s teacher also noted Leah’s exceptionally well-developed empathy and felt this was a result of immersion in play-based learning.

Social emotional development, I feel like she’s at the top of her class with that. She’s just very thoughtful in how she interacts with others. Really high skills with empathizing with others. And I feel like that’s something that you don’t often see in kindergartners. It takes a lot of development, but I feel like that’s something that [Leah] had walking into kindergarten. (Leah, 3rd Teacher Interview, p. 5)

Isaac’s teacher spoke of Isaac’s awareness of others’ emotions, especially classmates with disabilities. She stated that Isaac persists in these relationships because he wants to help these children succeed.

He sees these good strengths in the other kids. And even when it’s bothering him, he wants to be there to work through the issues, kind of like just an old soul in a sense that he kind of has this awareness and then the verbal skills to help this child through the process. (Isaac, 3rd Teacher Interview, p. 18)

Nadine’s mother spoke of how Nadine reacted to children who were emotionally distraught by extending compassion in emotionally charged situations.

And I feel like there are times when our kids have been upset, for sure, but we’ve heard what seems like trauma. Kids throwing chairs in the classroom and stuff that I don’t remember ever happening when I was in school. And our kids talk about it and say, someone had kind of a rough day or like lost control of his emotions, which I feel like was an incredible way to put it. (Nadine, 3rd Parent Interview, p. 24)

The purpose of this qualitative cross-case study was to describe the school readiness of four 5-year-old children entering kindergarten following play-based learning at a Reggio Emilia-inspired early childhood center. Participants described the children as learners, explorers, communicators, and empathizers, and believed the children were ready for kindergarten, engaged in creative thought, were responsive to novel learning experiences and classroom expectations, were well-versed in social communication and oriented towards connecting with others.

Literature addressing play and learning suggests children entering kindergarten following play-based early childhood education should excel in three key areas of school readiness. First, they should be excellent thinkers and learners who are curious about the world around them, capable of driving their learning and exploring their interests. Second, they should be fluent in emotional intelligence and adept at modifying their actions in accordance with group norms and social feedback. Finally, they should be confident in relationship building, readily forging connections with peers and adults and executing social reciprocity with ease (Harrington et al., 2020 ; Immordino-Yang et al., 2019 ; Taylor & Boyer, 2019 ).

Zosh et al. ( 2017 ) stated that children need to be ready to develop deeper conceptual understandings of the knowledge they acquire in school to be proficient learners and contributors to their classroom. Play provides recurring and novel opportunities for children to think deeply about the concepts they are learning, thus fostering complexity of thought and the development of complex schemas. Our findings offer evidence that play-based learning was effective in nurturing the thinking and understanding of the children who were the focus of this study. From Nadine’s careful recording of the pinecone shapes she observed in her backyard as she pondered the Fibonacci rule of spirals to Addy’s potion-making in the family bathtub, the children we studied took the information they learned and used it to investigate hypotheses and record their observations of nature. These children embodied the process of learning through self-directed exploration, which allowed them to make new discoveries and use the knowledge they acquired to serve a purpose.

Nilsson et al. ( 2018 ) championed play-as-learning because of the transformational changes play fosters within children as they enact societal roles and norms. Through play, children explore that which they have learned and discern how to apply or revise their knowledge in collaboration with others. Because play challenges children to leverage existing knowledge to solve social dilemmas, they become increasingly fluent in the process of reading social feedback and advocating for their position. Leah embodied this when she led negotiations among friends to determine acceptable rules for sharing a prized cape during dress-up play. Isaac’s teacher illustrated this through her observations of Isaac using his social capitol to include classmates with disabilities within the social hierarchy. Addy’s teacher observed this when she described Addy’s competency with reading social cues and following directions. In all cases, these children showed an ability to alter their behavior in response to social expectations.

Learning is inherently social, and children who are emotionally responsive have an easier time forming social connections (Harrington et al., 2020 ; Immordino-Yang et al., 2019 ). Establishing positive social relationships advantaged these children by allowing them to tap into the knowledge of others and learn collaboratively through group exploration. Addy’s teacher illustrated this when she reflected on Addy approaching a child sitting alone on the playground and inviting her to play. She noted that seeing Addy notice and extend an invitation to the solitary child was beyond the social maturity she expected of kindergarteners. Leah’s pursuit of a weekly meeting with her Assistant Principal also showed her prowess in building and sustaining relationships with others. Leah’s teacher’s description of her desire to “learn from the stories of others” shows the extent to which these children valued social connections and used their relationships with others to obtain new understandings.

These children’s proficiency in building relationships and social connections likely contributed to their success in kindergarten in many ways. One of our findings that was not explicit in play-based learning literature was the extent to which these children embraced challenges and persisted through difficulty. Burchinal et al. ( 2008 ) described the student–teacher relationship as the most impactful element of early learning in young children. The warm and trusting relationships these children fostered with their teachers likely contributed to their willingness to push themselves academically and accept constructive feedback to make progress as kindergarteners.

Through immersion in child-directed, exploratory learning, these children arrived at kindergarten with well-established schemas for acquiring and using new knowledge. They came from a background where they were encouraged to follow their interests and have voice in both the content and format of their educational experiences. Part of being the driver of your own learning is that you become adept at solving problems. This likely advantaged the children in that they saw themselves as co-creators of knowledge, capable of making meaningful contributions to their learning experiences. This was reflected when Leah’s teacher said that Leah showed “many ways of learning” and in Nadine’s mother’s comment that Nadine “kept that creative approach” when she was exposed to direct instruction in academic concepts and teacher-provided learning materials.

Our findings align with holistic views of education, given that the parents and teachers described these children as fluent with the non-constrained aspects of school readiness (Durkin et al, 2022 ; Taylor & Boyer, 2019 ). Their ability, however, to use social language and draw connections among concepts allowed them to master the more constrained elements of learning with persistence and enthusiasm. For example, Isaac was described as having the language skills to work through interpersonal problems with his peers and share his emotions with both his teacher and his mother, which helped him navigate social conflict and process his feelings of sadness or frustration. Because he was able to process emotional experiences in a supportive and productive manner, he was likely more available and present for classroom instruction.

The socioemotional school readiness attributes favored by teachers as preparing children for school are difficult to quantify, though parents and teachers readily observed them in the children studied. Time spent in play-based learning, where these children were empowered to follow their interests and actively collaborate with teachers and peers to co-create and lead their learning experiences, seemingly instilled within them a deep understanding of the learning process. These children arrived at kindergarten having established robust approaches to learning, which may have contributed to their competency with acquiring new knowledge and responding to various learning environments and teaching strategies. The children saw learning as an opportunity to pursue their interests, and as Nadine’s mother observed, when children set their own goals, they are much more likely to persevere through challenge.

The children who were the focus of this study faced many challenges beyond what would be expected during a typical school year and had access to fewer of the supports normally offered to buffer them against those stressors. The study of kindergarten transition during a time of high stress and uncertainty was likely, and perhaps surprisingly, an asset to our research, as the intensity of experiences faced by these children illuminated their readiness in unique and varied ways. For example, having to navigate changes in instructional format revealed participants’ prowess with cognitive flexibility and persistence, while learning from home showcased their ability to drive their interests and explore topics.

Conclusions

Early childhood educators and education policy makers face two fundamental questions when evaluating the readiness of children to enter kindergarten and benefit from formal education: (1) What foundational aptitudes best prepare children for long-term educational success? and (2) What pedagogical practices provide the optimal learning context for children prior to entering kindergarten? Children have many different life experiences that contribute to their readiness for kindergarten and perhaps it is more important to think about how various experiences prepare children for kindergarten rather than what experiences prepares children for kindergarten.

The children who were the focus of this study were very well prepared for successful kindergarten experiences by their time in play-based education. School readiness is a mindset that allows children to acclimate to and benefit from group learning contexts, requiring a certain adaptability and responsiveness to novelty and change to be successful. Perhaps play’s secret is its novelty and variation in challenging children to apply the knowledge they have and develop new understandings as situations become increasingly complicated; thus, preparing them for the challenge of kindergarten.

Limitations

The nature of qualitative research is to explore participant experiences within their natural context through an in-depth, rich account of a relatively small number of participants (Yin, 2018 ). Congruent with cross-case study and qualitative research paradigms, the descriptions of these children’s preparedness for school were derived from the collective perspectives of their mothers and kindergarten teachers and were not compared with other measures of school readiness such as school-administered assessments (which were cancelled because of the pandemic). The children who were the focus of this study were well-prepared for kindergarten following play-based learning and the participants’ descriptions helped to deepen readers’ understanding of the role of play in that preparation. Nonetheless, there are many influences on children’s early development, and we cannot definitively say how these children’s experiences would compare with children entering kindergarten from a non-play-based setting.

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Acknowledgements

The authors wish to acknowledge the Occupational Therapy at the Early Childhood Center Research Fund and the Wanda Mayberry Research Fund for their financial contributions to this research project. We also want to thank the Poudre School District Research Advisory Board for their support of the project. We also are grateful to the parents and teachers who participated in this study.

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Lisa Fyffe, Pat L. Sample & Anita C. Bundy

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All authors contributed to the study concept and design. LF collected all data and wrote the first draft of this manuscript. PS served as a second coder during analysis. AB, AL, and KR also read data excerpts and contributed to data analysis. All authors commented on previous versions of this manuscript and have read and approved of this final manuscript.

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Fyffe, L., Sample, P.L., Lewis, A. et al. Entering Kindergarten After Years of Play: A Cross-Case Analysis of School Readiness Following Play-Based Education. Early Childhood Educ J 52 , 167–179 (2024). https://doi.org/10.1007/s10643-022-01428-w

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A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy

• Magdalena Romanowicz   ORCID: orcid.org/0000-0002-4916-0625 1 ,
• Alastair J. McKean 1 &
• Jennifer Vande Voort 1  

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Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment.

Case presentation

A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.

Conclusions

The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

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There is a paucity of studies that address long-term effects of deprivation, trauma and neglect in early life, with what little data is available coming from institutionalized children [ 1 ]. Rutter [ 2 ], who studied formerly-institutionalized Romanian children adopted into UK families, found that this group exhibited prominent attachment disturbances, attention-deficit/hyperactivity disorder (ADHD), quasi-autistic features and cognitive delays. Interestingly, no other increases in psychopathology were noted [ 2 ].

Even more challenging to properly diagnose and treat are so called sub-threshold presentations of children with histories of early trauma [ 3 ]. Pincus, McQueen, & Elinson [ 4 ] described a group of children who presented with a combination of co-morbid symptoms of various diagnoses such as conduct disorder, ADHD, post-traumatic stress disorder (PTSD), depression and anxiety. As per Shankman et al. [ 5 ], these patients may escalate to fulfill the criteria for these disorders. The lack of proper diagnosis imposes significant challenges in terms of management [ 3 ].

J is a 4-year-old adopted Caucasian male who at the age of 2 years and 4 months was brought by his adoptive mother to primary care with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. J was given diagnoses of reactive attachment disorder (RAD) and ADHD. No medications were recommended at that time and a referral was made for behavioral therapy.

She subsequently took him to two different child psychiatrists who diagnosed disruptive mood dysregulation disorder (DMDD), PTSD, anxiety and a mood disorder. To help with mood and inattention symptoms, guanfacine, fluoxetine, methylphenidate and amphetamine salts were all prescribed without significant improvement. Later quetiapine, aripiprazole and thioridazine were tried consecutively without behavioral improvement (please see Table  1 for details).

No significant drug/substance interactions were noted (Table 1 ). There were no concerns regarding adherence and serum drug concentrations were not ordered. On review of patient’s history of medication trials guanfacine and methylphenidate seemed to have no effect on J’s hyperactive and impulsive behavior as well as his lack of focus. Amphetamine salts that were initiated during hospitalization were stopped by the patient’s mother due to significant increase in aggressive behaviors and irritability. Aripiprazole was tried for a brief period of time and seemed to have no effect. Quetiapine was initially helpful at 150 mg (50 mg three times a day), unfortunately its effects wore off quickly and increase in dose to 300 mg (100 mg three times a day) did not seem to make a difference. Fluoxetine that was tried for anxiety did not seem to improve the behaviors and was stopped after less than a month on mother’s request.

J’s condition continued to deteriorate and his primary care provider started risperidone. While initially helpful, escalating doses were required until he was on 6 mg daily. In spite of this treatment, J attempted to stab a girl at preschool with scissors necessitating emergent evaluation, whereupon he was admitted to inpatient care for safety and observation. Risperidone was discontinued and J was referred to outpatient psychiatry for continuing medical monitoring and therapy.

Little is known about J’s early history. There is suspicion that his mother was neglectful with feeding and frequently left him crying, unattended or with strangers. He was taken away from his mother’s care at 7 months due to neglect and placed with his aunt. After 1 month, his aunt declined to collect him from daycare, deciding she was unable to manage him. The owner of the daycare called Child Services and offered to care for J, eventually becoming his present adoptive parent.

J was a very needy baby who would wake screaming and was hard to console. More recently he wakes in the mornings anxious and agitated. He is often indiscriminate and inappropriate interpersonally, unable to play with other children. When in significant distress he regresses, and behaves as a cat, meowing and scratching the floor. Though J bonded with his adoptive mother well and was able to express affection towards her, his affection is frequently indiscriminate and he rarely shows any signs of separation anxiety.

At the age of 2 years and 8 months there was a suspicion for speech delay and J was evaluated by a speech pathologist who concluded that J was exhibiting speech and language skills that were solidly in the average range for age, with developmental speech errors that should be monitored over time. They did not think that issues with communication contributed significantly to his behavioral difficulties. Assessment of intellectual functioning was performed at the age of 2 years and 5 months by a special education teacher. Based on Bailey Infant and Toddler Development Scale, fine and gross motor, cognitive and social communication were all within normal range.

J’s adoptive mother and in-home therapist expressed significant concerns in regards to his appetite. She reports that J’s biological father would come and visit him infrequently, but always with food and sweets. J often eats to the point of throwing up and there have been occasions where he has eaten his own vomit and dog feces. Mother noticed there is an association between his mood and eating behaviors. J’s episodes of insatiable and indiscriminate hunger frequently co-occur with increased energy, diminished need for sleep, and increased speech. This typically lasts a few days to a week and is followed by a period of reduced appetite, low energy, hypersomnia, tearfulness, sadness, rocking behavior and slurred speech. Those episodes last for one to 3 days. Additionally, there are times when his symptomatology seems to be more manageable with fewer outbursts and less difficulty regarding food behaviors.

J’s family history is poorly understood, with his biological mother having a personality disorder and ADHD, and a biological father with substance abuse. Both maternally and paternally there is concern for bipolar disorder.

J has a clear history of disrupted attachment. He is somewhat indiscriminate in his relationship to strangers and struggles with impulsivity, aggression, sleep and feeding issues. In addition to early life neglect and possible trauma, J has a strong family history of psychiatric illness. His mood, anxiety and sleep issues might suggest underlying PTSD. His prominent hyperactivity could be due to trauma or related to ADHD. With his history of neglect, indiscrimination towards strangers, mood liability, attention difficulties, and heightened emotional state, the possibility of Disinhibited Social Engagement Disorder (DSED) is likely. J’s prominent mood lability, irritability and family history of bipolar disorder, are concerning for what future mood diagnosis this portends.

As evidenced above, J presents as a diagnostic conundrum suffering from a combination of transdiagnostic symptoms that broadly impact his functioning. Unfortunately, although various diagnoses such as ADHD, PTSD, Depression, DMDD or DSED may be entertained, the patient does not fall neatly into any of the categories.

This is a case report that describes a diagnostic conundrum in a young boy with prominent early life deprivation who presented with multidimensional symptoms managed with polypharmacy.

A sub-threshold presentation in this patient partially explains difficulties with diagnosis. There is no doubt that negative effects of early childhood deprivation had significant impact on developmental outcomes in this patient, but the mechanisms that could explain the associations are still widely unknown. Significant family history of mental illness also predisposes him to early challenges. The clinical picture is further complicated by the potential dynamic factors that could explain some of the patient’s behaviors. Careful examination of J’s early life history would suggest such a pattern of being able to engage with his biological caregivers, being given food, being tended to; followed by periods of neglect where he would withdraw, regress and engage in rocking as a self-soothing behavior. His adoptive mother observed that visitations with his biological father were accompanied by being given a lot of food. It is also possible that when he was under the care of his biological mother, he was either attended to with access to food or neglected, left hungry and screaming for hours.

The current healthcare model, being centered on obtaining accurate diagnosis, poses difficulties for treatment in these patients. Given the complicated transdiagnostic symptomatology, clear guidelines surrounding treatment are unavailable. To date, there have been no psychopharmacological intervention trials for attachment issues. In patients with disordered attachment, pharmacologic treatment is typically focused on co-morbid disorders, even with sub-threshold presentations, with the goal of symptom reduction [ 6 ]. A study by dosReis [ 7 ] found that psychotropic usage in community foster care patients ranged from 14% to 30%, going to 67% in therapeutic foster care and as high as 77% in group homes. Another study by Breland-Noble [ 8 ] showed that many children receive more than one psychotropic medication, with 22% using two medications from the same class.

It is important to note that our patient received four different neuroleptic medications (quetiapine, aripiprazole, risperidone and thioridazine) for disruptive behaviors and impulsivity at a very young age. Olfson et al. [ 9 ] noted that between 1999 and 2007 there has been a significant increase in the use of neuroleptics for very young children who present with difficult behaviors. A preliminary study by Ercan et al. [ 10 ] showed promising results with the use of risperidone in preschool children with behavioral dyscontrol. Review by Memarzia et al. [ 11 ] suggested that risperidone decreased behavioral problems and improved cognitive-motor functions in preschoolers. The study also raised concerns in regards to side effects from neuroleptic medications in such a vulnerable patient population. Younger children seemed to be much more susceptible to side effects in comparison to older children and adults with weight gain being the most common. Weight gain associated with risperidone was most pronounced in pre-adolescents (Safer) [ 12 ]. Quetiapine and aripiprazole were also associated with higher rates of weight gain (Correll et al.) [ 13 ].

Pharmacokinetics of medications is difficult to assess in very young children with ongoing development of the liver and the kidneys. It has been observed that psychotropic medications in children have shorter half-lives (Kearns et al.) [ 14 ], which would require use of higher doses for body weight in comparison to adults for same plasma level. Unfortunately, that in turn significantly increases the likelihood and severity of potential side effects.

There is also a question on effects of early exposure to antipsychotics on neurodevelopment. In particular in the first 3 years of life there are many changes in developing brains, such as increase in synaptic density, pruning and increase in neuronal myelination to list just a few [ 11 ]. Unfortunately at this point in time there is a significant paucity of data that would allow drawing any conclusions.

Our case report presents a preschool patient with history of adoption, early life abuse and neglect who exhibited significant behavioral challenges and was treated with various psychotropic medications with limited results. It is important to emphasize that subthreshold presentation and poor diagnostic clarity leads to dangerous and excessive medication regimens that, as evidenced above is fairly common in this patient population.

Neglect and/or abuse experienced early in life is a risk factor for mental health problems even after adoption. Differences in genetic risk, epigenetics, prenatal factors (e.g., malnutrition or poor nutrition), exposure to stress and/or substances, and parent-child interactions may explain the diversity of outcomes among these individuals, both in terms of mood and behavioral patterns [ 15 , 16 , 17 ]. Considering that these children often present with significant functional impairment and a wide variety of symptoms, further studies are needed regarding diagnosis and treatment.

Abbreviations

Attention-Deficit/Hyperactivity Disorder

Disruptive Mood Dysregulation Disorder

Disinhibited Social Engagement Disorder

Post-Traumatic Stress Disorder

Reactive Attachment disorder

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Romanowicz, M., McKean, A.J. & Vande Voort, J. A case of a four-year-old child adopted at eight months with unusual mood patterns and significant polypharmacy. BMC Psychiatry 17 , 330 (2017). https://doi.org/10.1186/s12888-017-1492-y

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Prof. Ariel Kalil reflects on the Behavioral Insights and Parenting Lab's decade of research on families

Ten years ago, Profs. Ariel Kalil and Susan Mayer co-founded the  Behavioral Insights and Parenting (BIP) Lab at the University of Chicago Harris School of Public Policy to better understand the science of decision-making among parents.

Over the past decade, the BIP Lab has conducted pathbreaking research that has strengthened families and improved children’s lives, while building partnerships with schools, governments and not-for-profits. We talked with Kalil, the Daniel Levin Professor at Harris, who co-directs the Lab along with Mayer, to discuss its impact—and what comes next:

What questions were you trying to answer when you launched the BIP Lab?

The central question, around which all others are based, is this: How do parents decide what they do to support their children’s development? It’s a big question. What makes a parent decide to read to their kid every day, or to choose a child care or pre-K environment? Similarly, how do they choose to show affection? Or what forms discipline takes? I wanted to understand what went into these decisions.

Parents aren't born to be types of parents: rather, parenting is characterized by the decisions parents make about how, and how often, they invest in their children to help them flourish. These decisions are shaped by an array of factors and subject to another array of constraints. As a developmental psychologist, this is how I think about what parents do.

Was this a natural next step in your research agenda?

Ten years ago, I was beginning to feel like the way I was approaching my research had run its course. I was mostly doing descriptive work with large-scale secondary data sets. I looked a lot like a demographer. I love demography, but I wanted something more ambitious and more challenging. There was a set of important, complex questions that I wanted to examine, but which required a vastly different approach for inquiry. First, answering these questions would require collecting my own data. Second, it would require an experimental approach, both in the lab and in the field. Third, it would require looking beyond developmental psychology for theories about why parents make the decisions they do. And, ultimately, it would mean taking those steps and innovating in a way that I hadn't done before.

Once I was set on this new path, I made the best decision of my career, which was to ask Susan Mayer if she was interested in joining forces. And thus we launched the Behavioral Insights and Parenting Lab in 2014. We’ve worked in lockstep ever since.

What are some of Lab's most important findings from the past ten years?

In simple terms: Parents procrastinate, parents are subject to cognitive biases and identity is important in parenting.

The bottlenecks to a parenting decision—like reading to your child before bedtime—are like the bottlenecks that can make it hard to do anything else in your life. Think of it as not going to the gym every day, despite signing up for a gym membership on January 1st, or not taking medicine every day, despite a doctor saying you should. These are basic activities that people forget about doing—or they know they should, and they just don't—and the same is true of parenting. Parenting is a series of decisions, just like anything else. The BIP Lab has been exploring how to overcome these tendencies people have.

We’re also discovering that technology helps overcome some of the barriers to parent-child engagement, because it can reduce some of the frictions that make it hard for parents to do what they intend. To that end, we’ve completed long-run experimental studies that have made a difference in areas such as decreasing chronic school absenteeism, improving early literacy skills, promoting early math skills, and improving parent engagement at home and with schools.

What are some other questions you’d like to tackle?

I’ve become really interested in exploring the idea that parenting is a team effort. We know this intuitively, but it doesn’t always get reflected in our analytic models. It’s not just performed by one person in the home.

I've done research revealing that kids get important inputs from all sorts of people who promote their development. In each day, kids receive time investment from not only their mother or father, but maybe also from a grandmother, an aunt, a friend, or a teacher. Many studies and programs consider only one parent at a time in thinking about promoting child development—an example of this is that parenting interventions are often designed for just one person, typically the mother.

I'd like to reimagine that. Raising children and investing in children is a group enterprise. It is conducted by individuals who are nested in families, who are in turn nested in peer groups, neighborhoods, cultures, and so on. I’d like to think more about how to measure and better understand this.

How do you think about the appropriate role for government to support child development?

Many government departments of education are, in effect, departments of schooling. But shouldn’t they really be departments of learning and education? The idea that education only happens in the school environment is flawed, and it leaves a giant hole in how we support kids' development. Children are at home most of the time, especially in the early years.

To this notion, I would like to see a wholesale re-understanding of the government's role in supporting parents. What should it be? How much should government reach into the sphere of the home environment? Not at all? A little bit? For what kinds of families? How would you do it in a way that respects privacy, and autonomy, and freedom of parents to choose what they want to do?

These are meaty questions that demand more study. And, for now, we lay a lot of responsibility on schools and teachers to educate children, and I find this perspective limited.

The BIP Lab has partnerships across Chicago and the state of Illinois. Why are partnerships so important?

At the heart of the BIP Lab is a partnership: the intellectual partnership that was formed between Susan Mayer and me. Our lab brings this ethos of collaboration and partnership to all the work we do. We are fortunate to have partnerships with hundreds of child care centers and school districts, with the State of Illinois (on our Governor Pritzker-backed  Chat2Learn initiative ), with the  Museum of Science and Industry , and many others. We’ve been able to build relationships of trust with these organizations that help bring our work to the next level.

Each year, our projects get bigger and more powerful. Partnerships have helped us raise research funds and a big merit of this is the many UChicago undergraduate and graduate students whom we can support to have research experiences.

What moments have proven unexpected and exciting at the BIP Lab?

The Illinois State Board of Education came to us for help during the COVID-19 pandemic. That was very gratifying. They were looking to us for a solution that would help parents interact with their kids while preschools were closed and parents were at home with their kids.

In response, we developed a tool called Chat2Learn, which is a text message-based, beautifully illustrated, open-ended question prompt program. It's for parents of preschool aged kids, and it sends a interesting open-ended conversation prompt every day to help parents talk with their kids in a way that builds not only kids' vocabulary, but also their sense of curiosity.

Chat2Learn’s defining feature is that it is a conversation starter, not a conversation stopper. It doesn't tell parents, "Ask your kids how many socks there are when you're folding the laundry,” or “Ask your kids how many squares there are on this window." Once you extract an answer like that out of your kids, the conversation is over. Instead, Chat2Learn asks open-ended questions: “What it would be like to have a pet giraffe?”, and other creative prompts. That conversation can go anywhere. We’re working now with a fabulous team of computer scientists to leverage AI and machine learning to take this tool to the next level of scale and ease of use.

What do you hope to see in the next ten years at the BIP Lab?

We want to focus on the opportunities that make the most impact. As many are, we're interested in technology and how it’s going to change society, social interactions and public policy. It could change so many aspects of education and child development, including how parents interact with their kids. It could change the nature of the home environment, and it could change these things for good or for ill. There is much to learn here.

The “ed tech explosion” has opened new avenues for partnership that hold great promise. Here at BIP Lab, we are collaborating with computer scientists, we're collaborating with tech companies—we never would have anticipated that. They're sharing their data; they're allowing us to do experimentation. We're working to develop AI integrations into the tools we’re developing, so that they can be more personalized, give parents feedback, and stimulate better parent-child interaction.

The bottom line is we want to continue to do the work that is both scientifically interesting and policy-relevant. We want to learn and do what we can to help all children reach their potential. And we want to train the next generation of Harris scholars who can change the world.

—Excerpted from a story that was published on the Harris Public Policy website. Read it in its entirety here.

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• About Adverse Childhood Experiences
• Risk and Protective Factors
• Program: Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action
• Adverse childhood experiences can have long-term impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include: 1

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with: 1

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination. 2 3 4 5 6

Quick facts and stats

ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs. 7

Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs. 1

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live. 5 6 ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work. 7

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. 8

ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. 9 Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide. 1 10 11 12 13 14 15 16 17

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress. Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning. 18

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. 18 These effects can also be passed on to their own children. 19 20 21 Some children may face further exposure to toxic stress from historical and ongoing traumas. These historical and ongoing traumas refer to experiences of racial discrimination or the impacts of poverty resulting from limited educational and economic opportunities. 1 6

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We all have a role to play.

• Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005. DOI: http://dx.doi.org/10.15585/mmwr.mm6844e1 .
• Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Science Direct. 2022; 22:7; 1105-1114. DOI: https://doi.org/10.1016/j.acap.2022.04.010 .
• Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood M. Risk Behaviors and Experiences Among Youth Experiencing Homelessness—Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts. Journal of Community Health. 2022; 47: 324-333.
• Experiencing discrimination: Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health | Annual Review of Public Health https://doi.org/10.1146/annurev-publhealth-090419-101940 .
• Sedlak A, Mettenburg J, Basena M, et al. Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Executive Summary. Washington, DC: U.S. Department of Health an Human Services, Administration for Children and Families.; 2010.
• Font S, Maguire-Jack K. Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse Negl. 2016;51:390-399.
• Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2 .
• Bellis, MA, et al. Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences Across Europe and North America: A Systematic Review and Meta-Analysis. Lancet Public Health 2019.
• Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 | MMWR
• Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7.
• Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N. Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstetrics & Gynecology . 2021;138(5):770-776. https://doi.org/10.1097/AOG.0000000000004570 .
• Sulaiman S, Premji SS, Tavangar F, et al. Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review. Matern Child Health J . 2021;25(10):1581-1594. https://doi.org/10.1007/s10995-021-03176-6 .
• Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. Journal of Pediatric Psychology . 2021;46(7):801-813. https://doi.org/10.1093/jpepsy/jsab027 .
• Mersky JP, Lee CP. Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC pregnancy and childbirth. 2019;19(1). https://doi.org/10.1186/s12884-019-2560-8 .
• Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. No youth left behind to human trafficking: Exploring profiles of risk. American journal of orthopsychiatry. 2019;89(6):704.
• Diamond-Welch B, Kosloski AE. Adverse childhood experiences and propensity to participate in the commercialized sex market. Child Abuse & Neglect. 2020 Jun 1;104:104468.
• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
• Narayan AJ, Kalstabakken AW, Labella MH, Nerenberg LS, Monn AR, Masten AS. Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction. Am J Orthopsych. 2017;87(1):3. https://doi.org/10.1037/ort0000133 .
• Schofield TJ, Donnellan MB, Merrick MT, Ports KA, Klevens J, Leeb R. Intergenerational continuity in adverse childhood experiences and rural community environments. Am J Public Health. 2018;108(9):1148-1152. https://doi.org/10.2105/AJPH.2018.304598 .
• Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. J Adolesc Health. 2013;53(4 Suppl):S32-38. https://doi.org/10.1016/j.jadohealth.2013.05.004 .

Adverse Childhood Experiences (ACEs)

ACEs can have a tremendous impact on lifelong health and opportunity. CDC works to understand ACEs and prevent them.

Blog The Education Hub

https://educationhub.blog.gov.uk/2024/05/16/new-rshe-guidance-what-it-means-for-sex-education-lessons-in-schools/

New RSHE guidance: What it means for sex education lessons in schools

R elationships, Sex and Health Education (RSHE) is a subject taught at both primary and secondary school.  

In 2020, Relationships and Sex Education was made compulsory for all secondary school pupils in England and Health Education compulsory for all pupils in state-funded schools.  

Last year, the Prime Minister and Education Secretary brought forward the first review of the curriculum following reports of pupils being taught inappropriate content in RSHE in some schools.  

The review was informed by the advice of an independent panel of experts. The results of the review and updated guidance for consultation has now been published.   

We are now asking for views from parents, schools and others before the guidance is finalised. You can find the consultation here .   

What is new in the updated curriculum?  

Following the panel’s advice, w e’re introducing age limits, to ensure children aren’t being taught about sensitive and complex subjects before they are ready to fully understand them.    

We are also making clear that the concept of gender identity – the sense a person may have of their own gender, whether male, female or a number of other categories   – is highly contested and should not be taught. This is in line with the cautious approach taken in our gu idance on gender questioning children.  

Along with other factors, teaching this theory in the classroom could prompt some children to start to question their gender when they may not have done so otherwise, and is a complex theory for children to understand.   

The facts about biological sex and gender reassignment will still be taught.  

The guidance for schools also contains a new section on transparency with parents, making it absolutely clear that parents have a legal right to know what their children are being taught in RSHE and can request to see teaching materials.   

In addition, we’re seeking views on adding several new subjects to the curriculum, and more detail on others. These include:   

• Suicide prevention  
• Sexual harassment and sexual violence  
• L oneliness  
• The prevalence of 'deepfakes’  
• Healthy behaviours during pregnancy, as well as miscarriage  
• Illegal online behaviours including drug and knife supply  
• The dangers of vaping   
• Menstrual and gynaecological health including endometriosis, polycystic ovary syndrome (PCOS) and heavy menstrual bleeding.  

What are the age limits?   

In primary school, we’ve set out that subjects such as the risks about online gaming, social media and scams should not be taught before year 3.   

Puberty shouldn’t be taught before year 4, whilst sex education shouldn’t be taught before year 5, in line with what pupils learn about conception and birth as part of the national curriculum for science.  

In secondary school, issues regarding sexual harassment shouldn’t be taught before year 7, direct references to suicide before year 8 and any explicit discussion of sexual activity before year 9.  

Do schools have to follow the guidance?  

Following the consultation, the guidance will be statutory, which means schools must follow it unless there are exceptional circumstances.   

There is some flexibility w ithin the age ratings, as schools will sometimes need to respond to questions from pupils about age-restricted content, if they come up earlier within their school community.   

In these circumstances, schools are instructed to make sure that teaching is limited to the essential facts without going into unnecessary details, and parents should be informed.  

When will schools start teaching this?  

School s will be able to use the guidance as soon as we publish the final version later this year.   

However, schools will need time to make changes to their curriculum, so we will allow an implementation period before the guidance comes into force.     

What can parents do with these resources once they have been shared?

This guidance has openness with parents at its heart. Parents are not able to veto curriculum content, but they should be able to see what their children are being taught, which gives them the opportunity to raise issues or concerns through the school’s own processes, if they want to.

Parents can also share copyrighted materials they have received from their school more widely under certain circumstances.

If they are not able to understand materials without assistance, parents can share the materials with translators to help them understand the content, on the basis that the material is not shared further.

Copyrighted material can also be shared under the law for so-called ‘fair dealing’ - for the purposes of quotation, criticism or review, which could include sharing for the purpose of making a complaint about the material.

This could consist of sharing with friends, families, faith leaders, lawyers, school organisations, governing bodies and trustees, local authorities, Ofsted and the media.  In each case, the sharing of the material must be proportionate and accompanied by an acknowledgment of the author and its ownership.

Under the same principle, parents can also share relevant extracts of materials with the general public, but except in cases where the material is very small, it is unlikely that it would be lawful to share the entirety of the material.

These principles would apply to any material which is being made available for teaching in schools, even if that material was provided subject to confidentiality restrictions.

Do all children have to learn RSHE?  

Parents still have the right to withdraw their child from sex education, but not from the essential content covered in relationships educatio n.  

You may also be interested in:

• Education Secretary's letter to parents: You have the right to see RSHE lesson material
• Sex education: What is RSHE and can parents access curriculum materials?
• What do children and young people learn in relationship, sex and health education

Tags: age ratings , Gender , Relationships and Sex Education , RSHE , sex ed , Sex education

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