PREDICTORS OF EARLY GRADE RETENTION AMONG CHILDREN IN THE UNITED-STATES

Background. Despite increasing concerns regarding school readiness, li ttle is known about child health correlates of early school failure am ong the general child population. The results of this study, conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of children in the Uni ted States, are reported here. Design. Analyses of data derived from i nterviews with parents of 9996 children ages 7 to 17 years who partici pated in the Child Health Supplement to the 1988 National Health Inter view Survey. Main Outcome Measures. History of repeating kindergarten or first grade. Results. Nationally 7.6% of children repeated kinderga rten or first grade. In a logistic regression model, factors independe ntly associated with increased risk of grade retention were: poverty [ Odds Ratio (On) 1.7, 95% confidence interval (CI) 1.4, 2.1], male gend er (OR 1.5, CI 1.3, 1.9), low maternal education (OR 1.4, CI 1.1, 1.8) ; deafness (OR 1.9, CI 1.4, 2.6), speech defects (OR 1.7, CI 1.1, 2.6) , low birth weight (OR 1.6, CI 1.2, 2.2), enuresis (OR 1.6, CI 1.1, 2. 2), and exposure to household smoking (OR 1.4, CI 1.1, 1.7). High mate rnal education (OR 0.6 CI 0.4, 0.9) and residence with both biological parents at age 6 years (OR 0.7, CI 0.6, 0.9) were independently assoc iated with a decreased risk of retention. Recurrent otitis media, blac k race, and low maternal age, although associated with early grade ret ention in bivariate analyses, were not independently associated with g rade retention in a model that controls for these other factors and fo r the age cohort of the child. Although omitted from the above predict ive model because of uncertainty about its temporal relation to early grade retention in this dataset, behavior problems at the time of inte rview have a strong independent association (OR 1.9, CI 1.5, 2.5) with prior early retention. Conclusions. This is the first study that uses national data to investigate how health and social factors individual ly and collectively contribute to early grade retention. It demonstrat es that early retention is common, that a number of extremely common c hild health problems are independently associated with it, and that th e magnitude of the heightened risk associated with these problems is s imilar to that of many of the well-recognized and difficult to change family and social risk factors for early retention. The successful imp lementations of Pub L 99-457 (The Education for All Handicapped Childr en Act Amendments of 1986) services in communities nationwide, and the improvement in the educational performance of large numbers of childr en will be facilitated by pediatricians' advocacy and surveillance for problems that place children at risk for educational failure, and by effective referral to and collaboration with nonpediatric child and fa mily services.