Abstract

Delays and inequalities in access to Special Educational Needs and Disability (SEND) provision in early childhood are likely to alter children’s social and education trajectories long-term. Effective policy solutions require robust evidence on the timing, duration, and contexts in which children with early indicators of need can access SEND provision.

We conducted a longitudinal study of 983,652 singleton children born in England in 2006-08 using ECHILD, a database containing linked hospital and state-funded school records. Nearly 16% of the study population had recorded SEND provision in Year 1 (age 5/6 years; 14.1% SEN Support, provided to children with less severe difficulties; 1.7% Education and Health Care Plan (EHCP), intended for those with more severe difficulties). SEN Support was more prevalent among males, those with pre-existing chronic health conditions and characterised by disadvantage and low Early Year Foundation Stage profile (EYFSP) scores. EHCP followed similar patterns but associations with disadvantage were weaker. Voluntary and academy sponsor-led schools were less likely to provide EHCPs, once known imbalances in pupil intake were accounted for.

Children entering state-funded education in nursery had higher prevalence of SEND provision throughout primary school than later entrants. EHCP increased gradually while SEN Support rose slowly, peaking at Year 2 (age 6/7 years) and then flattening. Children clustered into four trajectories of SEND provision from Year 1 to 6 labelled “Never”, “Stable-High”, “Decreasing” and “Increasing”. Those in the “Never” trajectory (77%) tended to live in income advantaged areas, had lower levels of chronic health conditions and higher EYFSP scores than peers. Children in the “Increasing” (i.e. delayed) trajectory were more likely to attend academy sponsor-led schools.

Results suggest that there are inequalities in type and timing of SEND provision that are associated with school governance.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This project is funded by the National Institute for Health Research (NIHR) under its `Programme Grants for Applied Research Programme' (Grant Reference Number NIHR202025, The HOPE Study). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. ECHILD is supported by ADR UK (Administrative Data Research UK), an Economic and Social Research Council (part of UK Research and Innovation) programme (ES/V000977/1, ES/X003663/1, ES/X000427/1). 

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The ECHILD Database uses data from the Department for Education (DfE). The DfE does not accept responsibility for any inferences or conclusions derived by the authors. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. Evidence from this research contributes to the NIHR Children and Families Policy Research Unit but was not commissioned by the NIHR Policy Research Programme. Permissions to use linked, de-identified data from HES and NPD were granted by NHS England (DARS-NIC-381972-Q5F0V-v0.5) and the Department for Education (DR200604.02B). Ethical approval for the ECHILD project was granted by the National Research Ethics Service (17/LO/1494), NHS Health Research Authority Research Ethics Committee (20/EE/0180 and 21/SW/0159). Separate ethical approval was not required to use de-identified data for the analyses presented in this paper.

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Data availability statement

The ECHILD database is made available for free for approved research based in the UK, via the ONS Secure Research Service. Enquiries to access the ECHILD database can be made by emailing ich.echilducl.ac.uk. Researchers will need to be approved and submit a successful application to the ECHILD Data Access Committee and ONS Research Accreditation Panel to access the data, with strict statistical disclosure controls of all outputs of analyses.

AbbreviationsEHCPeducation and health care planEYCearly years censusEYFSPearly years foundation stage profileECHILDEducation and Child Health Insights from Linked DataHEShospital episodes statisticsHOPEHealth Outcomes of young People throughout EducationIDACIIncome Deprivation Affecting Children IndexKS2key stage 2LAlocal authorityNPDNational Pupil DatabaseSENDspecial education need and disabilitiesSRSsecure research service