Educational Attainment of Children Born with Unilateral Cleft Lip and Palate in the United Kingdom

Abstract

Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.

Isolated oral clefts and school grades: population-based cohort study from Norway

“…However, the sample size is limited, and more studies are needed to examine the effect of cleft laterality. The tendency in England and Sweden that grades of females with clefts were more negatively affected than grades of males with clefts 6 9 was not replicated.…”

“…Indirect effects such as school absence have been found to affect educational attainment of children born with cleft in England, 7 whereas results from Western Australia showed that absence from school did not differentially disadvantage these children. 32 Low self-confidence has also been found to affect educational attainment for cleft children, 6 and appearance, social acceptance and interactions, bullying and poor integration in the school system may also play a role. 24 33–36 Several of these factors could be modifiable and thus important to identify.…”

“…Oral health, hearing and speech difficulties are directly related to the cleft itself [25][26][27][28][29] and have been shown to affect the educational attainment of individuals born with isolated cleft. 6 Atypical brain development 30 31 and exposure to anaesthesia during surgical treatment 14 have also been suggested to influence their academic achievement, although observations are uncertain due to small sample sizes. Indirect effects such as school absence have been found to affect educational attainment of children born with cleft in England, 7 whereas results from Western Australia showed that absence from school did not differentially disadvantage these children.…”

“… 4–7 A longitudinal cohort study from Iowa, tracking children’s academic achievement from elementary through high school, showed that children born with oral cleft are at higher risk for persistent, low achievement in school. 8 Previous research has suggested that lower school performance is more pronounced for females with cleft than males with cleft, 6 9 and that children with isolated left-sided cleft lip are more likely to have lower academic attainment than children with isolated right-sided cleft lip. 10 Comparisons across these studies are, however, hampered by differences in sample size, study recruitment, educational measures, age group of participants, adjustment for potential confounder variables and insufficient exclusion of non-isolated clefts.…”

“…3 Several studies have reported poor academic attainment in children born with isolated oral cleft compared with their unaffected peers. [4][5][6][7] A longitudinal cohort study from Iowa, tracking children's academic achievement from elementary through high school, showed that children born with oral cleft are at higher risk for persistent, low achievement in school. 8 Previous research has suggested that lower school performance is more pronounced for females with cleft than males with cleft, 6 9 and that children with isolated left-sided cleft lip are more likely to have lower academic attainment than children with isolated right-sided cleft lip.…”