Early academic achievement in children with isolated clefts: a population-based study in England

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.

Keywords: congenital abnorm; educational outcomes; isolated oral cleft.

Figure 1

Identification of study cohort.

Figure 2

Mean z-scores and 95% CIs for each area of learning at 5 years of age in children with an isolated cleft compared with the general population mean. See the text for further explanation. CD, creative development; CLL, communication, language and literacy; KUW, knowledge and understanding of the world; MAT, mathematical development; PD, physical development; PSE, personal, social and emotional development.

Figure 3

Mean z-scores and 95% CIs according to each area of learning at 5 years of age according to cleft type and compared with the general population mean. See the text for further explanation. BCLP, bilateral cleft lip and palate; CD, creative development; CL, cleft lip; CLL, communication, language and literacy; CP, cleft palate; KUW, knowledge and understanding of the world; MAT, mathematical development; PD, physical development; PSE, personal, social and emotional development; UCLP, unilateral cleft lip and palate.