Special Health Need among Canadian Kindergarten Children: A Pre-Post COVID-19 Onset Analysis Using the Early Development Instrument

Abstract

Background: The COVID-19 pandemic led to disruptions in healthcare, childcare, and early education programs, which may have affected children with special health needs (SHN) more severely than their typically developing peers. While medical diagnoses take time, kindergarten teachers’ observations can initiate early support for children at school. However, it remains unclear whether the proportion of children identified with SHN, based on teacher-reports, increased after the onset of COVID-19 pandemic. This thesis aimed to determine the proportion of Canadian kindergarten children identified with SHN before and after the onset of COVID-19 pandemic using the Early Development Instrument (EDI), and to examine the changes in mental health concerns among SHN children during this period.

Methods: Kindergarten teachers used the EDI to report SHN and mental health concerns for their students. EDI records were linked with sociodemographic data from the 2016 Canadian Census and 2015 Taxfiler data across 1,639 neighbourhoods to determine associations between SHN prevalence and neighbourhood-level socioeconomic status (SES).

Results: Among 485,543 kindergarteners, the study found that: (1) proportion of children with SHN increased after the onset of the pandemic (2) prevalence of SHN was inversely associated with neighbourhood-level SES, with a stronger association after the onset of pandemic, (3) the strength of this association varied across jurisdictions, and (4) while mental health concerns among SHN children increased, the adjusted odds of having mental health concerns were lower following the onset of the pandemic.

Conclusion: The findings indicate an overall rise in SHN prevalence, including a rise in mental health concerns among SHN children, following the onset of COVID-19 pandemic. A greater proportion of children with SHN resided in lower-SES neighbourhoods, with this association becoming more pronounced after the onset of the pandemic, suggesting widening inequities. The study points to the urgency for additional classroom support and early identification strategies for children who are showing signs of difficulty in kindergarten.