The relationship between academic performance and mental health among head start children
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The Relationship Between Academic Performance and Mental Health among Head Start Children. Proposal Presentation Doctor of Public Health Date of Presentation. DrPH Candidate Morgan State University School of Community Health and Policy. Presentation Outline. Introduction

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The relationship between academic performance and mental health among head start children

The Relationship Between

Academic Performance and Mental Health

among Head Start Children

Proposal Presentation Doctor of Public HealthDate of Presentation

DrPH Candidate

Morgan State University School of Community Health and Policy

Presentation outline
Presentation Outline

  • Introduction

    • Purpose of the Study

    • Background

    • Significance/Rationale

  • Literature Review

  • Methods

    • Research Questions and Hypotheses

    • Study Design

    • Analytical Framework

  • Study Implications, Strengths and Weaknesses

  • Questions

Purpose of the study
Purpose of the Study

To examine the relationship between academic performance and mental health among young children using a national Head Start sample


Mental Health – is a state of successful performance or mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity (Health People, 2010)


  • 22 -23% of the U.S. adult population or 44 million people have diagnosable mental disorders (Surgeon General, 2010)

  • Among the adult U.S. population, 19% have mutually exclusive mental health disorders, 3% have mental health disorders in conjunction with addictive behaviors (Surgeon General, 2010)

Background cont
Background cont.

  • 20% of children had mental health disorders which can account for functional impairment (Surgeon General’s Report on Mental Health, 1999)

  • 21% of children 9 to 17 had diagnosable mental or addictive disorder associated with at least minimum impairment (Surgeon General’s Report on Mental Health, 1999)

  • Mental and behavioral disorders can lead to school failure, alcohol or illicit drug use, violence, or suicide (Healthy People, 2010)

Background cont1
Background cont.

  • Two very important aspects of mental health development

    • Social Development

    • Emotional Development

Background cont2
Background cont.

  • Social development

    • Children who have a positive trust relationship and feel connected to their parents are often able to formulate better adaptive practices as they grow and mature in adolescence (Konaska, Aksan, Knaack & Rhines, 2004; Stolz, Barber, & Olsen, 2005)

    • Positive parenting relationship also leads to adolescents developing prosocial behaviors of being empathetic to the needs of others in various situations that may arise (Carlo, McGinley, Hayes, Batenhorst, & Wilkinson, 2007).

Background cont3
Background cont.

  • Emotional development

    • Children who feel emotionally their parents are not concerned about them often are more likely to fall prey to peer victimization, which often leads to a decline in their overall mental health (Rigby, Slee & Martin, 2007)

    • Children who feel that their parents are very dominant and try to maintain psychological control over them can lead to depression and antisocial behavior (Stolz, Barber & Olsen, 2005)

Theoretical framework
Theoretical Framework

  • Life Course Theory

    • Explores the notion that changing lives evolve along developmental trajectories (Elder, 1998)

    • Seeks to understand proximal experiences within the individual, the environment, and the individual environment interaction that contribute to the nonrandom distribution of mental health outcomes (Kellam, 1997)

Life course framework
Life Course Framework








Social Network


Social Network






Childhood Adolescence Young Adulthood Middle Ad.

Conceptual model
Conceptual Model



Family Context

Child Mental Health

Parent Mental Health

Academic Performance

Child Mental Health

Academic Performance

Life course
Life Course

  • Usefulness of life course model

    • In looking at patterns of life pathways over time

    • The life course helps to predict future outcomes based upon present factors

  • The major focus of the life course model is on the various social fields that one passes through in each stages of life (Kellam, 1997)

    • Social tasks are expected to be performed with specific criteria for success or failure

    • Natural rater who defines and evaluates the adequacy with which the tasks were completed

    • Natural rater changes based upon the social field in which one finds themselves

Mental health over the life course
Mental Health over the Life Course

  • 40 year longitudinal study of third grade students from ages 8 to 48 to examine the long term consequences of aggressive and antisocial behavior in childhood, adolescence, and young adulthood (Huesmann, Dubow & Boxer, 2009)

Mental health over the life course cont
Mental Health over the Life Course cont.

  • Parent as natural rater

    • Examined the association between parental major depressive and generalized anxiety disorders and child behavior problems (Meadows, McLanahan, & Brooks-Gunn, 2007)

    • Did an assessment of parenting and home environments (Leventhal, Selner-O’Hagan, Brooks-Gunn, Bingenheimer, and Earls , 2004)

Mental health over the life course cont1
Mental Health over the Life Course cont.

  • Parent/teacher/peer as natural raters

    • A study that looks at the teacher and parent as natural raters examined the implications for choosing certain instruments to establish eligibility for emotional and behavioral disorders among preschoolers (Feil, Small, Forness, Serna, Kaiser, Brooks-Gunn, et al., 2005)

    • Sought to get a better understanding of the associations between specific maltreatment types and aggression using a gender-informed approach. (Cullerton-Sen, Cassidy, Murray-Close, Cicchetti, Crick, and Rogosch, 2008)

Mental health over the life course cont2
Mental Health over the Life Course cont.

  • Parent/teacher/peer/child as natural raters

    • Determine whether mother and peers’ responses to direct and indirect aggression would contribute to children’s use of direct and indirect aggression (Valles & Knuston, 2008)

    • In this study, there was an investigation of the longitudinal relationships between self-system processes and depressive symptoms among maltreated and nonmaltreated children (Kim & Cicchetti, 2006).

Mental health over the life course cont3
Mental Health over the Life Course cont.

  • Child/Adult as natural raters

    • Healthy Passages was a comprehensive assessment of adolescent health and behavior using child, parent, and school reported data. (Wiesner, Chen, Winle, Elliott, Grunbaum, Kanouse, & Schuster 2010)

    • African American adults between the ages of 18 and 43 to examine psychological distress, stressful events, and religiosity (Lesniak, Rudmann, Rector & Elkin, 2006)

Family context and academic performance
Family Context and Academic Performance

  • The home environment is a major influence (positive/negative) on how children perform academically (Buckner, Bassuk & Beardslee, 2004; Kochanska, Aksan, Knaack, & Rhines, 2004; Carlo, McGinley, Hayes, Batenhorst, & Wilkinson, 2007 )

Family context and academic performance1
Family Context and Academic Performance

  • Positive parental involvement was positively related to academic performance (Niemeyer, Wong & Westerhaus, 2009)

  • Increased levels of consistent parental involvement in the school settings and reinforcement of concepts at home, there is an increase in the academic performance of the child (Hill, Castellino, Lansford, Nowlin, Dodge, Bates & Pettit, 2004)

Family context and academic performance2
Family Context and Academic Performance

  • Increase in the cognitive abilities of children in the areas of math and reading when parents had achievement related beliefs that they shared with their children on a regular basis (Neunenschwander, Vida, Garrett & Eccles, 2007)

  • Children who read books and sound out letters at home have better language and comprehension skill once they start school (Senechal & LeFevre, 2002; Raikes, Pan, Luze, Tamis-LeMonda, Brooks-Gunn, Constantine, et al, 2006)

Family context and academic performance3
Family Context and Academic Performance

  • Spillover occurred between family stressors and school problems across the high school years and was a predictor of poor academic performance in 12 grade (Flook & Fuligini, 2008)

  • Home environments where there are high levels of conflict and sporadic discipline paradigms often foster depressive symptoms among children exhibit conduct problems in school (Hill, Bush & Rosa, 2003)

School mental health and academic performance
School, Mental Health, and Academic Performance

  • Children who experience mental health issues are at increased risk of having issues with cognitive functioning (Reynolds, Girling, Coker & Eastwood, 2006)

  • Mental health issues often cause declines in attention and increases in hyperactivity which hinders children’s ability to take in information within the classroom setting (King, McDougall, DeWit, Hong, Miller, Offord, et al. 2005; Flannery, Wester & Singer, 2004)

Research gap
Research Gap

There is little understanding among young children how academic performance is affected by changes in mental health as they move from one grade to another.

Head start as setting for child development research
Head Start as Setting for Child Development Research

  • Study indicated differences social and emotional development processes among children in the enriched classrooms (Bierman, Domitrovich, Nix, Gest, Welsh, Greenberg, M.T., et al., 2008)

  • In the findings of the study, prosocial behavior with peers was high correlated with measures of academic performance, which included classroom participation, academic knowledge, and executive functioning (Bierman, Torres, Domitrovich, Welsh, & Gest, 2009)

Faces research
FACES Research

  • Significant direct effect found from neighborhood factors on Head Start children’s cognitive and behavioral outcomes. More specifically, primary caregiver education, household size, primary language spoken in the home, child’s gender and ethnicity were all significantly associated to multiple cognitive outcomes (Vaden, D’Elio, O’Brien, Tarullo, Zill, & Hubbell-McKey, 2010)

  • Children who spent two years in Head Start had better knowledge of letter and high frequency sight words than those children who spent one year or less. The letter word knowledge that the children received in Head Start were strong predictors of their abilities in kindergarten (Hammer, Farkas, and Maczuga, 2010)

Research questions and research hypotheses
Research Questions and Research Hypotheses

  • RQ1: What is the relationship between child mental health and academic performance?

    • H1: Better mental health will be associated with better academic performance for children in Head Start

  • RQ2: What effect does children’s academic performance have on their mental health when they move into kindergarten?

    • H2: Higher academic performing children will have better mental health after the transition from Head Start into kindergarten

Study design
Study Design

  • Observational longitudinal cohort study

  • Secondary data analysis from a study known as Head Start Family and Child Experiences Survey (FACES).

    • FACES is a study that examines areas such as cognitive, social, emotional, and physical development of Head Start children

Description of the survey instrument
Description of the Survey Instrument

  • The dataset includes information

    • Family characteristics - well-being and accomplishments of the families

    • School characteristics - quality of the Head Start classroom and characteristics, needs, and opinions of Head Start teachers and program staff

Description of the sample 2003 cohort
Description of the Sample: 2003 Cohort

  • Primary Sampling Units were created using information in the Head Start Information Report File

    • Broad profile on each program’s operations

    • Number of children

  • 1,669 programs were stratified into 30 strata with same number of enrolled children in each stratum

  • 30 strata were created using variables for (region, urban/rural, school based/other, percentage of non-English speaking children in program)

Description of the sample 2003 cohort1
Description of the Sample: 2003 Cohort

  • There were 60 program groups from 68 Head Start centers

  • 5 programs identified as not being in operation and became ineligible

Description of the sample 2003 cohort2
Description of the Sample: 2003 Cohort

  • A nationally representative sample of 2,400 newly entering 3 and 4 year old children and families in 63 Head Start programs

  • Four phases of data collection

    • Fall 2003

    • Spring 2004

    • Spring 2005

    • Spring 2006

Description of the sample 2003 cohort3
Description of the Sample: 2003 Cohort

Head Start Kindergarten

Fall 2003Spring 2004Spring 2005Spring 2005/06

3 yr cohort 3 yr cohort 3 yr cohort 3 yr cohort

4 yr cohort 4 yr cohort 4 yr cohort

Mental health
Mental Health

  • Aggression - Summary score of 4 items: disobeys rules, disrupts activities, hits others, and temper tantrums (Likert scale 0-2; range 0-8)

  • Hyperactivity - Summary score of 3 items: can’t concentrate, nervous, and restless (Likert scale 0-2; range 0-6)

  • Withdrawal - Summary score of 6 items: acts young, keeps to their self, lacks confidence, often sleepy, often unhappy, and worries

    (Likert scale 0-2; range 0-12)

  • Social Adaptation - Summary score of 12 items: follows direction, makes friends, not upset, joins activities, invites others, waits turn, puts away, gives compliments, says nice things, follows rules, -uses free time, and accepts ideas (Likert scale 0-2; range 0-24)

Mental health1
Mental Health

  • Please describe this child according to how true each of these statements has been during the past month…

    • Aggression

      • Has temper tantrums or hot temper

    • Hyperactivity

      • Is very restless, fidgets all the time, can’t sit still

    • Withdrawal

      • Often seems unhappy, sad, or depressed

    • Social Adaptation

      • Accepts classmates’ ideas for sharing and playing

Academic performance
Academic Performance

  • Reading - Summary score of a test that examines receptive vocabulary skills to recognize the meaning of words, but not necessarily use it correctly in a spoken or written expression.

  • Math - Summary score of a cognitive development test that measures children’s skills in analyzing and solving practical problems in mathematics

Study covariables
Study Covariables

Study covariables1
Study Covariables

Analytical model
Analytical Model

H1 H2

Child Mental Health (HS)


Child Mental Health (K)


Academic Performance (HS)

(math, reading)




Parent education

Parent beliefs

Parent mental health

Analytical plan
Analytical Plan

  • Frequencies and percentages for each of the variables (both qualitative and quantitative)

  • Means and standard deviations for all quantitative variables

  • Quartiles will be generated for quantitative variables with more than 10 unique values

Analytical plan1
Analytical Plan

  • Univariable analysis

    • Frequencies and percentages for each of the variables (both qualitative and quantitative)

    • Means and standard deviations for all quantitative variables

    • Quartiles will be generated for quantitative variables with more than 10 unique values

Analytical plan cont
Analytical Plan cont.

  • Bivariable analysis

    • To examine the association between the covariables (child mental health, parent interaction, parent mental health, parent beliefs, and academic performance) a correlation coefficient matrix was created.

    • Each of the variables was compared and the level of significance was determined.

Analytical plan cont1
Analytical Plan cont.

  • Multivariable analysis

    • Linear regression when academic performance is outcome

    • Logistic regression will be used to examine the relationship when mental health outcomes are dichotomized

    • Adjustments will be done for potential confounders or mediators, and interactions will be tested by adding interaction terms to the models

Analytical plan cont2
Analytical Plan cont.

  • In all analyses, study sampling design and weights were considered

  • Specifically, in STATA the SVY Module to handle the weights was used


  • Fills a very important gap area within the research on young children

  • Very large sample size from which the population was drawn

  • Longitudinal study, this study alone cannot establish causality


  • Use of secondary data

  • May not be generalizable outside of Head Start because the exposure may be unique to Head Start

  • This is one of various models that can be used. There may be other factors that are important

  • Imperfections that come in measuring mental health of children at such as young age


The proposed work has the potential to:

  • Provide foundation for additional studies to look at the relationship between mental health and academic performance relationship among young children

  • Increase the knowledge of the effects of Head Start in the academic development of a child

  • There was good evidence for understanding the relationships that takes place in the developmental process and also to make predictions on these effects over the life course


The proposed work has the potential to:

  • Further exploration of the relationship of these measures over time may be a validation to the fact that as development happens over the life course

  • More comprehensive, descriptive looks would need to be observed in order to really determine significance that the classroom environment plays on the mental health and academic performance of a child

  • Future research on other factors in the home environment that could be examined to see what influence they have on mental health and academic performance.


Acknowledgement Committee Members:

Parent interactions
Parent Interactions

  • In the past week, have you or someone in your family done the following things with [child]?

    • Told him/her a story

    • Taught him/her letter, words, or numbers

    • Taught him/her songs or music

Parent beliefs
Parent Beliefs

  • Here are some statements that parents of young children say about themselves

    • My child and I have warm intimate moments together

    • I encourage my child to be curious, to explore, and to question things

    • I encourage my child to be independent of me

Parent mental health
Parent Mental Health

  • Please tell me how often you have felt this way during the past week

    • Depressed

    • Fearful

    • You could not get going

Sample size
Sample Size

Estimated power for one-sample comparison of proportion to hypothesized value

Test Ho: p = 0.5000, where p is the proportion in the population


alpha = 0.0500 (two-sided)

alternative p = 0.6000

sample size n = 1609

Estimated power:

power = 1.0000