Factors Associated with Behavioral Problems in Pre-School Age: Secondary Data Analysis of Routine Examination at School Enrolment 2010/2014 in the Hannover Region

Abstract

Mental health and the prevalence of behavioral problems in children and adolescents has been gaining increasing concern in the last years. Several studies have addressed this issue in Germany. The aim of the study presented here is to examine factors associated with behavioral problems in pre-school children with focus on untreated morbidity. Data from the routine examination at school enrolment from 2010/11 to 2014/15 (n=40,675) in the Hannover region were analyzed. Behavioral problems and socio-emotional competences were assessed by the Strengths and Difficulties Questionnaire (SDQ) for parents and by doctors' observations during examination. Children who had already been treated for behavioral problems at the time of school enrolment were excluded from the study. Using multivariable logistic regression analyses, associations between behavioral problems and sociodemographic factors, duration of kindergarten attendance, family status and gestational age were assessed. Education level of the parents, calculated from both parents' highest school and professional education level, is the strongest predictor for assessing behavioral problems of children at the time of school enrolment examination (OR 2.5; 95%-CI 2.3-2.7). Further factors are male sex (OR 1.5; 95%-CI 1.4-1.6), no kindergarten attendance (OR 1.3; 95%-CI 1.02-1.6) or kindergarten attendance of only one year (OR 1.4; 95%-CI 1.2-1.6), children living without their biological parents (OR 1.7; 95%-CI 1.2-2.4), preterm births (OR 1.5; 95%-CI 1.2-1.8) and age of 5 ½ years and younger (OR 1.4; 95%-CI 1.3-1.6) at the time of examination. The results point to the importance of early development support for children from socially disadvantaged families. The results highlight public health-relevant points and enable the region Hannover to improve preventive efforts targeting such pre-school children.