School absence and achievement in children with isolated orofacial clefts

Abstract

ObjectivesTo examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England.DesignAnalysis of educational data linked to national cleft registry and administrative hospital data.SettingEnglish state schools.Patients3523 children with isolated clefts aged 7 years between 2006 and 2014.Main outcome measuresAnnual school absence and reaching the national ‘expected level’ according to teacher-assessed academic achievement.ResultsChildren with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%).ConclusionsSchool absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs.

Retrospective Evaluation of Number of Surgeries and Parent Ratings of Academic and Behavioral Functioning Among Children With Isolated Oral Clefts

“…Additionally, the connection between later timing of surgery and lower cognitive performance at 2 and 7 years old was found to be mediated by maternal interactions at 2 months of age (Murray et al, 2008; Hentges et al, 2011). However, Fitzsimons and colleagues (2020) found that while school absence was associated with school attainment at 7 years, it did not explain cleft type differences where those with palatal involvement had lower attainment.…”

Academic achievement and needs of school‐aged children born with selected congenital anomalies: A systematic review and meta‐analysis

“…Studies in Europe, USA and Australia using school test results were consistent in reporting lower achievement in children with OFC in various school age groups compared to controls (Bell et al, 2017b;Clausen et al, 2017;Fitzsimons et al, 2018;Fitzsimons et al, 2021;Grewal et al, 2020;Persson et al, 2012;Watkins et al, 2018;Wehby et al, 2014), however, the significant differences were not consistent for all academic domains and OFC types (Table 2). Findings from most studies of children with isolated OFC agreed that poorer academic outcomes were associated with cleft type, reporting a lower risk for children with cleft lip only, who often performed similarly to controls (Bell et al, 2017b;Clausen et al, 2017;Fitzsimons et al, 2018;Fitzsimons et al, 2021;Persson et al, 2012;Watkins et al, 2018;Wehby et al, 2014). There was less consistency for cleft palate and cleft lip with palate (CLP), with significantly higher risks for both groups reported in some studies (Fitzsimons et al, 2018;Fitzsimons et al, 2021), but for cleft palate only in others (Persson et al, 2012;Wehby et al, 2014) or CLP (Watkins et al, 2018).…”

“…Findings from most studies of children with isolated OFC agreed that poorer academic outcomes were associated with cleft type, reporting a lower risk for children with cleft lip only, who often performed similarly to controls (Bell et al, 2017b;Clausen et al, 2017;Fitzsimons et al, 2018;Fitzsimons et al, 2021;Persson et al, 2012;Watkins et al, 2018;Wehby et al, 2014). There was less consistency for cleft palate and cleft lip with palate (CLP), with significantly higher risks for both groups reported in some studies (Fitzsimons et al, 2018;Fitzsimons et al, 2021), but for cleft palate only in others (Persson et al, 2012;Wehby et al, 2014) or CLP (Watkins et al, 2018). Longitudinal studies showed that children with isolated OFC were at higher risk of lower performance across all academic areas and grade levels, from elementary to high school (7-17 years), in particular for children with cleft palate (Wehby et al, 2014) (Table S6).…”

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

“… 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. 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.…”

“…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.…”