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Abstract
Objectives We used national data to study differences in academic achievement between 5-year-old children with an isolated oral cleft and the general population. We also assessed differences by cleft type.
Methods Children born in England with an oral cleft were identified in a national cleft registry. Their records were linked to databases of hospital admissions (to identify additional anomalies) and educational outcomes. Z-scores (signed number of SD actual score is above national average) were calculated to make outcome scores comparable across school years and across six assessed areas (personal development, communication and language, maths, knowledge of world, physical development andcreative development).
Results 2802 children without additional anomalies, 5 years old between 2006 and 2012, were included. Academic achievement was significantly below national average for all six assessed areas with z-scores ranging from −0.24 (95% CI −0.32 to −0.16) for knowledge of world to −0.31 (−0.38 to −0.23) for personal development. Differences were small with only a cleft lip but considerably larger with clefts involving the palate. 29.4% of children were documented as having special education needs (national rate 9.7%), which varied according to cleft type from 13.2% with cleft lip to 47.6% with bilateral cleft lip and palate.
Conclusions Compared with national average, 5-year-old children with an isolated oral cleft, especially those involving the palate, have significantly poorer academic achievement across all areas of learning. These outcomes reflect results of modern surgical techniques and multidisciplinary approach. Children with a cleft may benefit from extra academic support when starting school.
- congenital abnorm
- isolated oral cleft
- educational outcomes
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Footnotes
Handling editor Martin Ward Platt
Contributors KJF: conceptualised and designed the study, carried out the analyses and interpretation of data, drafted the initial manuscript, revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. JHvdM and SAD: conceptualised and designed the study, reviewed and edited the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. LPC: conceptualised and designed the study, coordinated and managed the data collection from the three datasets, processed the Hospital Episode Statistics data, commented on the initial manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. LD: critically reviewed the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. ES: carried out the dataset linkage rate analyses, commented on the initial manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. SCC: assisted in the statistical analyses of the data, commented on the initial manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Funding This work was funded by the National Specialised Commissioning Group for England and the Wales Specialised Health Services Committee and was carried out by the team of the CRANE database (the National Cleft Database of England, Wales, and Northern Ireland), which is overseen by the UK NHS Cleft Development Group. The funders did not have a role in in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. JvdM is partly supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The study cohort was identified in the Cleft Registry and Audit Network (CRANE) database. CRANE records were linked to Hospital Episode Statistics and National Pupil Database. Data can be shared if approval has been obtained from the owners of these three databases.