Learning Trajectories of Children With Special Health Care Needs Across the Severity Spectrum

doi:10.1016/j.acap.2014.09.001

Academic Pediatrics

Volume 15, Issue 2, March–April 2015, Pages 177-184

https://doi.org/10.1016/j.acap.2014.09.001 Get rights and content

Abstract

Objective

A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years.

Methods

The Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children which commenced in May 2004. Data were analyzed from the LSAC kindergarten cohort (n = 4,983), as well as a subsample of 720 children for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development at school entry that includes SHCN.

Results

Latent class analysis was utilized to establish 3 academic trajectories from 4–5 to 10–11 years: high (24.3%), average (49.8%), and low (23.6%). Descriptive statistics revealed a trend for both children with established and emerging SHCN to fall into weaker performing learning pathways. Multinomial logistic regression focusing on those children with emerging SHCN confirmed this pattern of results, even after adjustment for covariates (relative risk 3.06, 95% confidence interval 1.03–9.10). Children who additionally had low socioeconomic standing were particularly at risk.

Conclusions

Even children with less complex SCHN are at risk for academic failure. Early identification, together with integrated health and educational support, may promote stronger pathways of educational attainment for these children. Achieving these better outcomes will require the involvement of both educational and health practitioners.

Section snippets

Impact of SHCN on Learning and School Achievement

Children with SHCN tend to begin school with weaker early academic skills than their peers,⁶ and disparate academic outcomes continue to be evident in the later elementary years.⁹ In the long term, these children have lower rates of high school completion, postsecondary education, and decreased earnings and labor market participation.¹⁰ Many different factors are likely to contribute to these poorer outcomes, such as school absenteeism, decreased participation at school, and restricted

Data Sources

Growing Up in Australia: the Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children—the birth cohort (B cohort) of 5,107 infants and the kindergarten cohort (K cohort) of 4,983 4-year-olds—which commenced in May 2004.²¹ A cluster design and stratification of postal codes were used to ensure a geographically representative sample of the Australian population for each age cohort, with the exception of

Sample Characteristics

The K cohort subsample with AEDI data included 720 children (n = 351, 48.75% boys and n = 369, 51.25% girls). A substantial proportion of children in this sample were classified as having SHCN, including 3.89% (n = 28) with established SHCN and 16.67% (n = 120) with emerging SHCN. The remainder of the sample (n = 572, 79.44%) formed the standard population. Children with SHCN in this sample experienced a diverse range of difficulties, including a large proportion with psychosocial problems such

Discussion

A significant proportion of children in this sample experienced SHCN at school entry, including 4% with formally identified special needs and 17% with emerging SHCN, consistent with Australian population estimates.⁶ These children were overrepresented in poorly performing academic pathways as they moved through the elementary school years. Importantly, the risk of being on a poorer academic trajectory was clearly apparent for children with emerging needs, despite these children often being

Conclusions

Children with SHCN, including those with emerging health and developmental concerns, are at increased risk for poorer learning pathways through the educational system. The current findings suggest that weaknesses evident at school entry tend to continue and even worsen over the elementary school years, particularly for disadvantaged children. Flexible, multidisciplinary, and timely intervention is needed to support children with SHCN such that they can achieve their full potential at school.

Acknowledgments

There are a number of key groups to be acknowledged for their support of the Australian Early Development Index (AEDI), including the following: the Australian government, which funded the study; all schools, principals, and teachers across Australia who participated in the AEDI; and each of the state and territory AEDI coordinators and their coordinating committees, who helped to facilitate the AEDI data collection in their respective jurisdictions. We appreciate their time and commitment.

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Design: Longitudinal data from Waves 3 and 4 in the Longitudinal Study of Australian Children (83% of 4983 retained). Exposures (8–9 years): Physical health adversities (yes/no; summed range, 0–5): overweight, special health care needs, chronic illness, PedsQL Physical, and global health. Psychosocial health adversities (yes/no; summed range, 0–4): parent- and teacher-reported behavior, PedsQL Psychosocial, sleep problems. Combined health adversities (range 0-9). Outcomes (8–9, and 10–11 years): National academic standardized test scores. Analysis: Generalized estimating equations, accounting for multiple academic domains in each year and socioeconomic position and cognition.
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A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children's emerging SHCN across the family and school contexts relates to service utilization.
Sample: The nationally representative birth cohort of the Longitudinal Study of Australian Children, which includes parent reports on the abbreviated Children with Special Health Care Needs Screener. For a subsample of 2459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN. Analysis: Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage.
Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared with those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.10–0.81). Similarly, children with parent-only (OR, 0.39; 95% CI, 0.20–0.75) and teacher-only (OR, 0.25; 95% CI, 0.14–0.46) identified needs had significantly lower odds of accessing services in the community.
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Citation Excerpt :
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Preterm, low-birth-weight (LBW) children are at increased risk for poor academic achievement and special health care needs (SHCN) compared to term-born peers. It is not known how having SHCN during childhood modifies the relationship between LBW and achievement over time.
We used data from the Infant Health and Development Program, a multisite randomized trial of an intervention for preterm, LBW infants with longitudinal follow-up. Primary outcome measures were Woodcock-Johnson Tests of Academic Achievement math and reading scores at age 8 and 18 years. Primary predictor was having a SHCN, defined by prescription medication and medical services use, receipt of special therapies, or any functional limitation. We used repeated measures multivariate analysis of covariance to test the effect of SHCN on achievement at 8 and 18 years and effect modification by IQ.
The 576 participants had a mean body weight of 1798.1 ± 455.0 g and a median gestational age of 33 weeks (range, 26–37 weeks). Mean achievement scores were as follows: math (age 8) 97.5 ± 21.6, math (age 18) 90.1 ± 18.3, reading (age 8) 99.0 ± 20.1, and reading (age 18) 96.8 ± 23.5. Mean full scale IQ at age 8 was 92.3 ± 18.2. Eighty percent had a SHCN. Mean achievement scores were significantly different between those with and without SHCN in both math and reading. There was no evidence of effect modification by IQ.
SHCNs are associated with poor academic achievement. Targeted interventions for improving performance outcomes by reducing the burden of chronic health problems may be accomplished through prevention strategies or efforts to limit the frequency and severity of symptoms.
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View all citing articles on Scopus

: The authors declare that they have no conflict of interest.

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Issues for Children with Special Health Care NeedsLearning Trajectories of Children With Special Health Care Needs Across the Severity Spectrum

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Impact of SHCN on Learning and School Achievement

Data Sources

Sample Characteristics

Discussion

Conclusions

Acknowledgments

Child Youth Serv Rev

J Pediatr

Addressing the millennial morbidity: the context of community pediatrics

Pediatrics

Child health 2000: new pediatrics in the changing environment of children’s needs in the 21st century

Pediatrics

Differentiating subgroups of children with special health care needs by health status and complexity of health care needs

Matern Child Health J

A new definition of children with special health care needs

Pediatrics

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

Prevalence and correlates of special health care needs in a population cohort of Australian children at school entry

J Dev Behav Pediatr

Children at risk for special health care needs

Pediatrics

Public services for children with special needs: discrimination by diagnosis?

J Paedr Child Health

School outcomes of children with special health care needs

Pediatrics

Transition from high school to work or college: how special education students fare

Future Child

An epidemiologic profile of children with special health care needs

Pediatrics

Disproportionality in special needs education in England

J Spec Educ

A national profile of health care utilization and expenditures for children with special health care needs

Arch Pediatr Adolesc Med

Patterns of School Readiness Among Selected Subgroups of Canadian Children: Children With Special Needs and Children With Diverse Language Backgrounds

Inequality at the Starting Gate: Social Background Differences in Achievement as Children Begin School

Issues for Children with Special Health Care Needs
Learning Trajectories of Children With Special Health Care Needs Across the Severity Spectrum