Exclusion From Childcare Centre Attendance in Toddler and Preschool Patients in a Psychiatric Day Clinic: Patterns From Comparison of a 2018/2019 and a 2023/2024 Cohort.

The study looked back at records, so it can show what went together but not what caused what. Everything comes from one clinic in one region of Germany, so the numbers may not transfer to your service. The excluded groups were small, and the 2018/2019 group especially: only six children. The authors say this limits how stable the links with sex and with cohort are. The model was good at ruling exclusion out and poor at picking it out, with sensitivity of 9.4%, partly because only 18% of the sample had been excluded. No follow-up after treatment, so nothing is known about how these children fared later. Only eight children had a full exclusion, so full and partial exclusions could not be compared separately. Diagnoses were deliberately left out of the model, so no diagnosis or behaviour pattern could be tested as a predictor. Missing data (3.77% of values) were filled in by single imputation rather than dropping cases. The difference between the two cohorts may reflect changes in referral pathways, greater awareness and detection, or pressure on services rather than a real rise in exclusion.

The work was funded in part by the Innovative Medizinische Forschung of the medical faculty of the University of Muenster, awarded to one of the authors; the German Research Foundation (DFG) is also named as a funder. The authors declare no conflicts of interest.

Do not read the higher exclusion figures for 2023/2024 as proof that childcare exclusions are genuinely rising. The authors themselves say the difference could come from changed referral pathways, more detection and different diagnostic practice, and that it is a difference between two cohorts in a single clinical sample. The 2018/2019 excluded group was also tiny, at six children.