Newswise — Children who enter kindergarten behind in social-behavioral development are more likely to be held back, need more individualized supports and services, and be suspended or expelled, according to new research by the Johns Hopkins School of Nursing’s Deborah Gross, DNSc, RN, FAAN, Amie Bettencourt, PhD, and Grace Ho, PhD, RN. The recently-released study, which focused on Baltimore City Public Schools, resonates nationwide as social, emotional, and behavioral difficulties are now top chronic disabilities affecting children.

The study examined the relationship between kindergarteners’ social-behavioral readiness and key educational outcomes in over 9,000 elementary school students. The results showed that by the time they reached 4th grade, students who were considered socially and behaviorally “not ready” for school were:

--Up to 80% more likely to be retained in their grade--Up to 80% more likely to receive services and supports through an Individualized Education Plan (IEP) or a 504 Plan geared toward children with disabilities--Up to 7 times more likely to be suspended or expelled at least once

Boys were also more likely to be assessed as not socially and behaviorally ready in kindergarten and to experience all three academic difficulties.

“These results are important,” says Gross, professor and the Leonard and Helen Stulman Endowed Chair in Mental Health and Psychiatric Nursing. “They show how critical social and behavioral skills are for learning, how early the struggle begins for young children, and how important it is to address the problem of social-behavioral readiness well before children enter kindergarten.”

From increased likelihood of dropping out of school to decreased success in the workplace, the research shows that these outcomes put strain on families, schools, and societies. “In 2015, kindergarten teachers rated more than half of students behind in social and behavioral skills needed for learning, and it’s painful for the children who want to succeed, but become frustrated and hopeless,” says Gross.

The study also points to the additional costs associated with providing educational support, lost wages among parents needing to supervise children who have been suspended or expelled, and juvenile justice involvement that often follows school dropout.

Ho, a PhD alumna who conducted this work while a Morton and Jane Blaustein Post-doctoral Fellow in Mental Health and Psychiatric Nursing, adds that even though children first learn social-behavioral skills within their homes and family environment, development can be hindered among kids whose families are affected by chronic stress, poverty, or traumatic experiences. “More than 30 percent of Baltimore City children are exposed to such events, and it directly impacts their ability to manage emotions, focus attention, and process information.”

To help cut the high cost of not being socially and behaviorally ready for school, the researchers recommend a comprehensive strategy calling for schools and cities to promote social-behavioral readiness by expanding and enhancing early childhood programming and strengthening supports for parents and teachers.

“These programs may be costly,” says Bettencourt, first author of the report and director of the ChiPP Project. “But not addressing the problem of readiness to learn will cost more in the long run. It’s in the best interest of all to invest in strengthening social and behavioral foundations for our kids and for future generations.”

This study was conducted in collaboration with the Baltimore Education Research Consortium (BERC) and is also part of the ChiPP Project, an initiative to strengthen parenting and parent engagement in schools through implementation of the Chicago Parent Program in City Schools starting in pre-kindergarten.

See the full study results.

Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research and practice and ranks #1 nationally among graduate schools of nursing and #6 for online programs, according to U.S. News & World Report. In addition, the school was named the “Most Innovative Nursing Graduate Program in the U.S.” by Best Master of Science in Nursing Degrees, and ranks #1 among nursing schools for Federal Research Grants and National Institutes of Health (NIH) funding. For more information, visit