Childhood‐onset type 1 diabetes and attention‐deficit/hyperactivity disorder with educational attainment: A population‐based sibling‐comparison study

Abstract

Aim To examine the association of childhood‐onset type 1 diabetes (T1D) and attention‐deficit/hyperactivity disorder (ADHD) with educational outcomes from compulsory school to university. Methods Using multiple Swedish nationwide registers, we followed up on 1,474,941 individuals born in Sweden from 1981–1995 to December 31, 2013. Associations of T1D and ADHD with achieving educational milestones (from compulsory school to university) and school performances were estimated using logistic and linear regression models and sibling comparison models. Results Compared to their peers, children with both T1D and ADHD were less likely to achieve any of the educational attainments, including completing compulsory school (adjusted OR [aOR] [95% CI]: 0.43 [0.26, 0.72]), be eligible to and finishing upper secondary school (0.26 [0.19, 0.36], 0.24 [0.17, 0.35], respectively), and starting university (0.38 [0.17, 0.90]). The odds of achieving these educational milestones were substantially lower in children with ADHD alone (aORs: 0.14–0.44), but were slightly worse or no differences in children with T1D alone (aORs: 0.86–1.08). All associations above remained similar in the sibling comparison models. Conclusion Children and adolescents with both T1D and ADHD had long‐term educational underachievement, with ADHD being the major contributor. Our findings suggest the importance of assessing ADHD in children with T1D and targeted support for minimising the education gap between the affected children and their peers.

Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders

“…One small cross-sectional study of 39 adolescents with T1D reported that a higher level of depression was associated with lower grades in mathematics, science, and English. A previous study found that, in Sweden, individuals with both T1D and ADHD experienced more educational difficulties compared with their peers. Nevertheless, studies remain needed to understand whether and how specific psychiatric disorders interfere with educational attainment in patients with T1D.…”

“…Consistent with previous cohort studies, we estimated the association of T1D and psychiatric disorders with educational outcomes using logistic regression models for binary outcomes (ie, achieving educational milestones) and linear regression models for continuous outcomes (ie, GPA). For each outcome, we initially modeled T1D and any psychiatric disorder while accounting for their interactions.…”

Issue Highlights

“…Liu et al carried out a Swedish population‐based cohort study of 1.47 million individuals to compare the academic performances of children with and without type 1 diabetes, attention deficit hyperactivity disorder (ADHD) or both. Children with these conditions were less likely to go to university, and their school performances were inferior to their peers 6 . ADHD was the major contributor.…”