Third-grade School Performance in Children with Special Healthcare Needs: a Prospective Cohort Study

Overview

Journal BMJ Paediatr Open

Publisher BMJ Publishing Group

Specialty Pediatrics

Date 2024 Dec 4

PMID 39631793

Authors

Jennifer Schlecht

Jochem Konig

Stefan Kuhle

Michael S Urschitz

Affiliations

Soon will be listed here.

Abstract

Objective: Children with special healthcare needs (SHCN) due to a chronic health condition perform more poorly at school compared with their classmates. We aimed to estimate the effects of past, current, transient, emerging and persistent SHCN on school performance in primary school children.

Methods: Data from the German population-based prospective cohort study ikidS were used. The children withSHCN screener was administered before school entry (T1) and at the end of first (T2) and third grade (T3). Grades for German, maths and science (range: 1 (Very Good) to 6 (Failure)) were obtained at the end of third grade (age 8-9 years), and an average grade was calculated. Associations between the timing of SHCN and average grade were estimated by mixed linear regression models adjusted for potential confounding variables.

Results: 751 children were included, and 21% had ever SHCN. Children with ever SHCN had poorer school performance than children with never SHCN (adjusted mean difference in average grade [95% CI]: 0.17 [0.06; 0.28]). SHCN in the third year were associated with a poorer average grade (0.29 [0.16; 0.41]) compared with healthy children. Only emerging (0.31 [0.15; 0.48]) and persistent (0.25 [0.07; 0.43]) SHCN were associated with average grade.

Conclusions: This study demonstrates the negative effect of current, emerging and persistent SHCN on academic performance in primary school children. Consequently, students should be regularly assessed for SHCN during school age. Timely interventions may help reduce the adverse effects of chronic health conditions on academic achievements in childhood.

References

Forrest C, Bevans K, Riley A, Crespo R, Louis T . School outcomes of children with special health care needs. Pediatrics. 2011; 128(2):303-12. PMC: 3387854. DOI: 10.1542/peds.2010-3347. View

Quach J, Barnett T . Impact of chronic illness timing and persistence at school entry on child and parent outcomes: Australian longitudinal study. Acad Pediatr. 2014; 15(1):89-95. DOI: 10.1016/j.acap.2014.08.004. View

Bethell C, Read D, Stein R, Blumberg S, Wells N, Newacheck P . Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambul Pediatr. 2002; 2(1):38-48. DOI: 10.1367/1539-4409(2002)002<0038:icwshc>2.0.co;2. View

Hoffmann I, Diefenbach C, Graf C, Konig J, Schmidt M, Schnick-Vollmer K . Chronic health conditions and school performance in first graders: A prospective cohort study. PLoS One. 2018; 13(3):e0194846. PMC: 5870990. DOI: 10.1371/journal.pone.0194846. View

Quach J, Jansen P, Mensah F, Wake M . Trajectories and outcomes among children with special health care needs. Pediatrics. 2015; 135(4):e842-50. DOI: 10.1542/peds.2014-2431. View

Winkler J, Stolzenberg H . [Social class index in the Federal Health Survey]. Gesundheitswesen. 2000; 61 Spec No:S178-83. View

Goldfeld S, OConnor M, Quach J, Tarasuik J, Kvalsvig A . Learning trajectories of children with special health care needs across the severity spectrum. Acad Pediatr. 2014; 15(2):177-84. DOI: 10.1016/j.acap.2014.09.001. View

Scheidt-Nave C, Ellert U, Thyen U, Schlaud M . [Prevalence and characteristics of children and youth with special health care needs (CSHCN) in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007; 50(5-6):750-6. DOI: 10.1007/s00103-007-0237-3. View

Schlecht J, Konig J, Urschitz M . [Chronically ill at School - School Performance in Children with Special Health Care Needs. Results of the Child Health Study ikidS]. Klin Padiatr. 2022; 234(2):88-95. DOI: 10.1055/a-1672-4709. View

10.

Bethell C, Read D, Blumberg S, Newacheck P . What is the prevalence of children with special health care needs? Toward an understanding of variations in findings and methods across three national surveys. Matern Child Health J. 2007; 12(1):1-14. DOI: 10.1007/s10995-007-0220-5. View

11.

Schlecht J, Konig J, Kuhle S, Urschitz M . School absenteeism in children with special health care needs. Results from the prospective cohort study ikidS. PLoS One. 2023; 18(6):e0287408. PMC: 10289337. DOI: 10.1371/journal.pone.0287408. View

12.

Van Cleave J, Gortmaker S, Perrin J . Dynamics of obesity and chronic health conditions among children and youth. JAMA. 2010; 303(7):623-30. DOI: 10.1001/jama.2010.104. View

13.

Schlecht J, Hammerle F, Konig J, Kuhle S, Urschitz M . Teachers reported that children with special health care needs displayed more attention problems. Acta Paediatr. 2024; 113(5):1051-1058. DOI: 10.1111/apa.17125. View

14.

McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P . A new definition of children with special health care needs. Pediatrics. 1998; 102(1 Pt 1):137-40. DOI: 10.1542/peds.102.1.137. View