摘要：Objectives. We investigated relationships among cognitive delay, community factors, and behavior problems over 2 years in early childhood with a national sample of US families. Methods. Data were from 3 waves of the Early Childhood Longitudinal Study, Birth Cohort (2001–2005; n = 7650). We defined cognitive delay as the lowest 10% of mental scores from the Bayley Short Form–Research Edition, administered at 9 and 24 months. At 24 months, we classified children as typically developing or as having resolved, newly developed, or persistent cognitive delays. Behavior was measured at age 4 years with the Preschool and Kindergarten Behavior Scales (range = 0–36). Community factors included perceived neighborhood safety and an index of county disadvantage. Results. Behavior scores at age 4 years (mean = 12.4; SD = 4.9) were higher among children with resolved (Β = 0.70; SE = 0.20), newly developed (Β = 1.92; SE = 0.25), and persistent (Β = 2.96; SE = 0.41) cognitive delays than for typically developing children. The interaction between county disadvantage and cognitive delay status was statistically significant ( P < .01), suggesting that county disadvantage was particularly detrimental for children with persistent delays. Conclusions. The community context may provide an opportunity for public health interventions to improve the behavioral health of children with cognitive delays. Children with cognitive delays develop behavior problems at much higher rates than do their typically developing peers. 1–5 Such problems have been shown to emerge at very young ages 6 and to persist through school age into adulthood, 7,8 contributing to a wide range of negative consequences for children’s health and well-being. 9,10 Despite these marked disparities, there has been very little research to date to inform the mechanisms underlying the development of behavior problems among children with cognitive delays, especially in early childhood. 1,11 In a recent review, Einfeld et al. 1 noted that few studies reporting on the prevalence of mental health or behavior problems among children with cognitive delays have examined associated risk factors beyond age, gender, and severity of the child’s limitation. Further inquiry into factors associated with behavior problems among children with cognitive delays is needed to illuminate the etiology of such problems and inform future intervention studies. From a social–ecological perspective, 12,13 the contextual environment in which children with cognitive delays grow and develop may contribute to their risk for behavior problems. A number of studies have shown significant associations between community and neighborhood socioeconomic factors and young and early school-aged children’s mental health, internalizing and externalizing behavior problems, 14 and criminal, delinquent, and violent behaviors. 15–17 It is possible that young children with cognitive delays who are prone to health and developmental difficulties are especially sensitive to their community’s social and economic characteristics. However, to our knowledge, the relationship between community factors and behavior problems has not yet been examined among children with cognitive delays. Therefore, the purpose of this study was to investigate the relationships among cognitive delay, community factors, and behavior problems in early childhood by using a national sample of US children. We focused on very early childhood as it is a critical period for the development of behavior problems among children with cognitive delays. 6 We expected to observe significant disparities in behavior problems between 4-year-old children with and without cognitive delays. Furthermore, we hypothesized that children with cognitive delays living in adverse community environments would be particularly vulnerable to developing behavior problems. To our knowledge, this is the first study to investigate the role of community factors on behavior problems among young children with cognitive delays.
