Socioeconomic status amplifies the achievement gap throughout compulsory education independent of intelligence

The eTHINK Study: Cognitive and Behavioral Outcomes in Children with Hemophilia

OBJECTIVE

To assess cognitive, behavioral, and adaptive functions in children and young adults with hemophilia treated according to contemporary standards of care.

STUDY DESIGN

Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK) is a US-based, prospective, cross-sectional, observational study (September 2018 through October 2019). Males (aged 1-21 years) with hemophilia A or B of any severity, with or without inhibitors, were eligible. Participants underwent neurologic examinations and age-appropriate neuropsychological assessments, including standardized tests/ratings scales of early development, cognition, emotional/behavioral adjustment, and adaptive skills.

RESULTS

Five hundred and fifty-one males with hemophilia A (n = 433) or B (n = 101) were enrolled. Performance on cognitive tests was largely comparable with that of age-matched US population norms, although participants in certain age groups (4-5 and 10-21 years) performed worse on measures of attention and processing speed. Furthermore, adolescents and young adults and those with comorbid attention-deficit/hyperactivity disorder (ADHD; n = 64) reported more adaptive and executive function problems in daily life. Incidence of ADHD in adolescents (21%) was higher than expected in the general population.

CONCLUSIONS

In general, males with hemophilia demonstrated age-appropriate intellectual, behavioral, and adaptive development. However, specific patient/age groups showed poorer attention performance and concerns for executive and adaptive development. This study established a normative data set for monitoring neurodevelopment in individuals with hemophilia and highlight the importance of screening and intervention for challenges with cognitive and adaptive skills in this population.

CLINICAL TRIAL REGISTRATION

Evolving Treatment of Hemophilia's Impact on Neurodevelopment, Intelligence, and Other Cognitive Functions (eTHINK); NCT03660774; https://clinicaltrials.gov/ct2/show/NCT03660774.

Parental socioeconomic status weakly predicts specific cognitive and academic skills beyond general cognitive ability

Parental socioeconomic status (SES) is a well-established predictor of children's neurocognitive development. Several theories propose that specific cognitive skills are particularly vulnerable. However, this can be challenging to test, because cognitive assessments are not pure measures of distinct neurocognitive processes, and scores across different tests are often highly correlated. Aside from one previous study by Tucker-Drob, little research has tested if associations between SES and cognition are explained by differences in general cognitive ability rather than specific cognitive skills. Using structural equation modelling (SEM), we tested if parental SES is associated with individual cognitive test scores after controlling for latent general cognitive ability. Data from three large-scale cohorts totalling over 16,360 participants from the UK and USA (ages 6-19) were used. Associations between SES and cognitive test scores are mainly (but not entirely) explained through general cognitive ability. Socioeconomic advantage was associated with particularly strong vocabulary performance, unexplained by general ability. When controlling for general cognitive ability, socioeconomic disadvantage was associated with better executive functions. Better characterizing relationships between cognition and adversity is a crucial first step toward designing interventions to narrow socioeconomic gaps. RESEARCH HIGHLIGHTS: Understanding environmental influences on cognitive development is a crucial goal for developmental science-parental socioeconomic status (SES) is one of the strongest predictors. Several theories have proposed that specific cognitive skills, such as language or certain executive functions, are particularly susceptible to socioeconomic adversity. Using structural equation modelling, we tested whether SES predicts specific cognitive and academic tests after controlling for latent general cognitive ability across three large-scale cohorts. SES moderately predicted latent general cognitive ability, but associations with specific cognitive skills were mainly small, with a few exceptions.

Self-perceptions as mechanisms of achievement inequality: evidence across 70 countries

Children from lower socioeconomic status (SES) backgrounds tend to have more negative self-perceptions. More negative self-perceptions are often related to lower academic achievement. Linking these findings, we asked: Do children's self-perceptions help explain socioeconomic disparities in academic achievement around the world? We addressed this question using data from the 2018 Programme for International Student Assessment (PISA) survey, including n = 520,729 records of 15-year-old students from 70 countries. We studied five self-perceptions (self-perceived competency, self-efficacy, growth mindset, sense of belonging, and fear of failure) and assessed academic achievement in terms of reading achievement. As predicted, across countries, children's self-perceptions jointly and separately partially mediated the association between socioeconomic status and reading achievement, explaining additional 11% (ΔR2 = 0.105) of the variance in reading achievement. The positive mediation effect of self-perceived competency was more pronounced in countries with higher social mobility, indicating the importance of environments that "afford" the use of beneficial self-perceptions. While the results tentatively suggest self-perceptions, in general, to be an important lever to address inequality, interventions targeting self-perceived competency might be particularly effective in counteracting educational inequalities in countries with higher social mobility.

Associations of physical activity dose and movement quality with executive functions in socioeconomically disadvantaged children aged 5-6 years

BACKGROUND

Growing up in areas of high deprivation can negatively impact children's movement behaviours and cognitive development. Enhancing the quantity and quality of children's movement experiences is believed to enhance cognitive development. This study investigated the association of three different modes of movement assessment, movement proficiency and divergent movement ability (collectively understood as motor competence) and PA dose with executive function in a low socio-economic demographic. Demographics, motor competence, and a combination of motor competence and physical activity were hypothesized to be significantly predictor of executive functions.

METHOD

In this cross-sectional study, 360 children aged 5-6 years from deprived areas were assessed using three movement assessments: wrist-worn accelerometery for physical activity dose, Test of Gross Motor Development-3 for movement proficiency, and divergent movement assessment. Executive function, including inhibitory control, working memory, and cognitive flexibility, was measured using the NIH Toolbox on an iPad. Multiple linear regression models were designed to evaluate the independent and combined association of demographics, movement competence and physical activity variables with executive function.

RESULTS

The regression analysis, with demographic factors only, explained 12% of EF variance (r2 = 0.12 95%CI 0.06-0.18). In addition to this demographics the model with divergent movement explained 19% of EF variance (r2 = 0.19 95% CI = 0.12-0.28), the model with movement proficiency explained 16% of EF variance (r2 = 0.16 95% CI = 0.08-0.26) and the model with PA dose explained 13% of EF variance (r2 = 0.13 95% CI = 0.07-0.20). In these models both divergent movement and proficiency were significant predictors, whilst physical activity variables were not. The final models, combining motor competence and physical activity variables, explained 24% and 23% of EF variance (r2 = 0.24 CI = 0.14-0.33 and r2 = 0.23 CI = 0.14-0.32). In these models, motor competence variables were significant predictors, and only vigorous physical activity and Euclidean Norm Minus One emerged as significant PA dose predictors.

DISCUSSION

These findings emphasise that motor competence and physical activity variables better predict executive functions when they are combined. When considered individually both motor competence variables were significant predictors of executive function whilst physical activity variables were not. Importantly, among the two movement competence facets, divergent movement assessment exhibited the strongest association with executive function. Future interventions should consider how to facilitate both movement and cognitive development in children. Future interventions should consider both the interplay of movement quality and quantity and the importance of environments that invite children's exploratory movement behavior.

Predicting School Grades: Can Conscientiousness Compensate for Intelligence?

Intelligence and noncognitive factors such as conscientiousness are strongly related to academic performance. As theory and research differ with respect to their interplay in predicting performance, the present study examines whether conscientiousness compensates for intelligence or enhances the effect of intelligence on performance in 3775 13th grade students from Germany. Latent moderation analyses show positive main effects of intelligence and conscientiousness on grades. Further, analyses reveal synergistic interactions in predicting grades in biology, mathematics, and German, but no interaction in predicting grades in English. Intelligence and grades are more strongly linked if students are conscientious. Multigroup models detected gender differences in biology, but no differences with respect to SES. In biology, conscientiousness has especially strong effects in intelligent men. Conscientiousness thus enhances the effect of intelligence on performance in several subjects.

Widening Digital Divide: Family Investment, Digital Learning, and Educational Performance of Chinese High School Students During the COVID-19 Pandemic School Closures

The COVID-19 pandemic and school closures highlighted the need for research examining the effects of socio-economic status and digital learning on educational performance. Based on a panel dataset from a Chinese high school during school closures in 2020, our study explored whether the digital divide widened during the pandemic. The results showed that digital learning significantly mediates the association of socio-economic status with educational performance. In contrast, the indirect effects of digital learning were not significant before the outbreak of the COVID-19 pandemic. However, these effects immediately became significant during school closures and remote education instruction during the pandemic. After the schools reopened, the indirect effects of digital learning declined or even disappeared. Our findings provide new evidence for a widening digital divide during the COVID-19 pandemic school closures.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11482-023-10191-y.

Social determinants of neurocognitive and academic performance in sickle cell disease

BACKGROUND

Sickle cell disease (SCD) is associated with poor neurocognitive outcomes due to biomedical and psychosocial factors. The aims of this study were to investigate associations between household and neighborhood socioeconomic status (SES) with cognitive and academic outcomes in SCD and to determine if these relationships were modified by sickle genotype, fetal hemoglobin, or age.

PROCEDURE

We prospectively recruited patients to complete a battery of neurocognitive and academic measures. Household SES was measured using the Barratt Simplified Measure of Social Status, a composite index of parent education and occupation. The Social Vulnerability Index was used to classify individuals based on social vulnerabilities at the neighborhood level.

RESULTS

Overall, 299 patients between the ages of 4 and 18 (mean = 11.4, standard deviation = 4.3) years diagnosed with SCD (57% SS/SB0 -thalassemia) completed testing. Stepwise multivariate models demonstrated that patients with low social vulnerability (i.e., high SES) at the neighborhood level displayed intelligence and math scores that were 4.70 and 7.64 points higher than those living in areas with moderate social vulnerability, respectively (p < .05). Reading performance did not differ based on neighborhood SES; however, the effect of neighborhood SES was dependent on age, such that older participants living in neighborhoods with moderate or high levels of social vulnerability displayed poorer reading scores than those with low social vulnerability (p < .05).

CONCLUSIONS

This study identified patients with SCD at higher risk of poor academic performance based on SES. Interventions addressing academic difficulties should be offered to all children with SCD, but should be emergently offered to this subpopulation.

School Readiness Test and Intelligence in Preschool as Predictors of Middle School Success: Result of an Eight-Year Longitudinal Study

Research has shown that the development of cognitive and social skills in preschool predicts school readiness in kindergarten. However, most longitudinal studies are short-term, tracking children’s development only through the early elementary school years. This study aims to investigate the long-term impact of preschool predictors, intelligence, and mothers’ education on grade six school performance. This study presents the results of an eight-year-long longitudinal study. The sample includes 202 Hungarian children (89 boys) from a disadvantaged region of southeastern Hungary. The independent variables were the preschool measures: DIFER (Diagnostic System for Assessing Development), a widely used, standardized school readiness test that measures cognitive and social skills; the Raven intelligence test; and socioeconomic status. The dependent variables in grade six were: National Standardized tests in math and reading (NABC, National Assessment of Basic Competencies) and school grades (GPA). Cronbach’s alpha reliability of each test is above 0.76. Correlations and a series of multiple regressions were used for analysis. All three independent variables have significant predictive power for school performance in sixth grade. DIFER skills were the best predictors for reading achievement, intelligence for math achievement, and GPA was best predicted by mothers’ education. The results show that developing preschool skills, mothers’ education and IQ in preschool are essential to long-term learning success.

Persistent association between family socioeconomic status and primary school performance in Britain over 95 years

In Britain and elsewhere, the influence of family socioeconomic status (SES) on education is already evident in primary school, and it persists and increases throughout the school years, with children from impoverished families earning lower grades and obtaining fewer educational qualifications than children from more privileged backgrounds. Reducing the effect of family background on children's education is a pivotal aim of educators, policymakers, and researchers, but the success of their efforts is poorly evidenced to date. Here, we show for the first time that over 95 years in Britain the association between family SES and children's primary school performance has remained stable. Across 16 British population cohorts born between 1921 and 2011 (N = 91,935), we confirmed previous findings of a correlation between family SES and children's school performance of 0.28 [95% Confidence Interval 0.22-0.34], after adjusting for cohort-specific confounders. Contrary to the popular assumption that family background inequality has increased over time, we observed only minimal differences in the association between family SES and school performance across British cohorts. We argue that education policies must prioritize equity in learning outcomes over equality in learning opportunities, if they seek to disrupt the perpetuation of social and economic inequality across generations. We speculate that the influence of family SES on children's education will only noticeably weaken if primary education settings become better equipped to meet and remediate the children's differential learning needs.

Factors Related with Underperformance in Reading Proficiency, the Case of the Programme for International Student Assessment 2018

Almost 217 million secondary school students (60% of the world's adolescents) do not reach minimum levels in reading proficiency at the end of secondary school, according to objective 4.1 of the UN's Sustainable Development Goals. Therefore, the early and efficient identification of this disadvantage and implementation of remedial strategies is critical for economies. In 2018, the Programme for International Student Assessment (PISA) assessed the reading skills of 15-year-old students in 80 countries and economies. This work introduces a methodology that uses PISA's data to build logistic regression models to identify the main factors contributing to students' underperforming reading skills. Results showed that socioeconomic status (SES), metacognition strategies, Information and Communication Technology (ICT) skills, and student-teacher relationships are the most important contributors to low reading abilities.

Examining the relationships among adolescent health behaviours, prefrontal function, and academic achievement using fNIRS

•

Prior studies document effects of lifestyle behaviors on the brain and academics.

•

Among adolescents we found that activity and eating both predict task performance.

•

Activity also predicts functional activation in the right lateral dlPFC, but not grades.

•

Substance use predicted worse grades but not brain-related mediators.

Several adolescent health behaviours have been hypothesized to improve academic performance via their beneficial impact on cognitive control and functional aspects of the prefrontal cortex (PFC). The primary objective of this study is to examine the association between lifestyle behaviours and academic performance in a sample of adolescents, and to examine the extent to which activity within the PFC and behavioural indices of inhibition may mediate this relationship. Sixty-seven adolescents underwent two study sessions five days apart. Sleep and physical activity were measured using wrist-mounted accelerometry; eating habits, substance use and academic achievement were measured by self-report. Prefrontal function was quantified by Multi-Source Interference Task (MSIT) performance, and task-related activity via functional near-infrared spectroscopy (fNIRS). Higher levels of physical activity predicted higher MSIT accuracy scores (β = .321, ρ = 0.019) as well as greater activation within the right dlPFC (b = .008, SE = .004, ρ = .0322). Frequency of fast-food consumption and substance use were negatively associated with MSIT accuracy scores (β = −0.307, ρ = .023) and Math grades (b = −3.702, SE = 1.563, ρ = .022), respectively. Overall, the results of this study highlight the importance of lifestyle behaviours as predictors of prefrontal function and academic achievement in youth.

Creative expressiveness in childhood writing predicts educational achievement beyond motivation and intelligence: A longitudinal, genetically informed study

BACKGROUND

Creativity is linked with educationally relevant constructs such as achievement, intelligence, and motivation. However, very few studies have explored longitudinal links between the constructs or the aetiology of individual differences in childhood creativity.

AIMS

The study addresses the gap in the literature of developmental studies on the relationship of creativity with other educationally relevant measures. Additionally, the present study is the first adequately powered genetically informative analysis of childhood creativity.

SAMPLE(S)

The present study utilized data from 1,306 twins, a subsample from a longitudinal, representative twin sample in the UK.

METHODS

Creativity was operationalised as a Creative Expressiveness score, using the Consensual Assessment Technique on stories written by 9-year-olds. Intelligence and writing motivation were assessed at age 9. Academic achievement was collected at ages 9, 12, and 16.

RESULTS

Creative Expressiveness was associated with intelligence and motivation, all measured at age 9. It also predicted variance in English grades at ages 9 and 16. The associations were weak, but significant, over and above intelligence, motivation, and earlier English grades. The variance in Creative Expressiveness was explained by genetic (35%), shared environmental (21%), and non-shared environmental (45%) influences. The phenotypic correlations with other study variables were mainly mediated genetically.

CONCLUSIONS

The results provide information that can be used for planning educational content. First, creativity can be detected in childhood writing. Second, childhood creativity may be overlooked in early educational assessments. Third, the results from the genetic analyses are important indications on the role of environments in the development of creativity.

A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood

The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.

School quality ratings are weak predictors of students' achievement and well-being

BACKGROUND

In England, all state-funded schools are inspected by an independent government agency, the Office for Standards in Education, Children's Services and Skills (Ofsted). Inspections aim to hold schools accountable and to promote the improvement of education, with the results made available to the public. Ofsted reports intend to index school quality, but their influence on students' individual outcomes has not been previously studied. The aim of the current study was to explore the extent to which school quality, as indexed by Ofsted ratings, is associated with students' educational achievement, well-being and school engagement.

METHODS

We use an England population-based sample of 4,391 individuals, for whom school performance at age 11 and GCSE grades at age 16 were accessed from the National Pupil Database, and who completed measures of well-being and school engagement at age 16.

RESULTS

We found that Ofsted ratings of secondary school quality accounted for 4% of the variance in students' educational achievement at age 16, which was further reduced to 1% of the variance after we accounted for prior school performance at age 11 and family socioeconomic status. Furthermore, Ofsted ratings were weak predictors of school engagement and student well-being, with an average correlation of .03.

CONCLUSION

Our findings suggest that differences in school quality, as indexed by Ofsted ratings, have little relation to students' individual outcomes. Accordingly, our results challenge the usefulness of Ofsted ratings as guides for parents and students when choosing secondary schools.

A Systematic Overview of Meta-Analyses on Socioeconomic Status, Cognitive Ability, and Achievement: The Need to Focus on Specific Pathways

Meta-analyses on the relation between socioeconomic status (SES) and performance on measures of cognitive ability and achievement arrive at the same general conclusion of a small to medium association. Advancements in methods make possible for meta-analyses to examine specific pathways linking SES to cognitive ability and achievement, as well as the moderators of these pathways. In this study, we conducted a systematic overview of meta-analyses on SES to address three research questions: 1) what is the direction and overall strength of association between SES and performance on measures of cognitive ability and achievement, and how precise are the effect sizes reported? 2) to what extent have meta-analyses examined moderation by components of SES, age, sex, and race/ethnicity? and 3) to what extent have meta-analyses examined mechanisms linking SES to cognitive ability and achievement? We conducted a systematic search using online archives (i.e., PsycINFO, ERIC, PubMed, Sociological Abstracts, and Web of Science), searching issues in Psychological Bulletin and Review of Educational Research, and examining references and citations. We identified 14 meta-analyses published between 1982 and 2019. These meta-analyses consistently reported positive associations of small to medium magnitude, indicating that SES is a meaningful contributor to the development of cognitive ability and achievement. Fewer meta-analyses reported evidence of moderation by age, sex, and race/ethnicity. None of the meta-analyses directly examined mechanisms, but provided evidence of possible mechanisms for future research. We suggest that meta-analyses can increase their contribution to future research, interventions, and policy by narrowing their focus on specific pathways.

Preschool Verbal and Nonverbal Ability Mediate the Association Between Socioeconomic Status and School Performance

We compared the extent to which the long‐term influence of family socioeconomic status (SES) on children's school performance from age 7 through 16 years was mediated by their preschool verbal and nonverbal ability. In 661 British children, who completed 17 researcher‐administered ability tests at age 4.5 years, SES correlated more strongly with verbal than nonverbal ability (.39 vs. .26). Verbal ability mediated about half of the association between SES and school performance at age 7, while nonverbal ability accounted for a third of the link. Only SES, but not verbal or nonverbal ability, was associated with changes in school performance from age 7 to 16. We found that SES‐related differences in school performance are only partly transmitted through children's preschool verbal abilities.

Performance of public and private school students in auditory processing, receptive vocabulary, and reading comprehension

Abstract: Purpose: To characterize the performance of 5th grade students from public and private elementary schools in auditory processing, receptive vocabulary, and reading comprehension. Methods: The study sample was composed of 34 Elementary School (5th grade) students: 16 from public school (PubG) and 18 from private school (PrivG), whose parents and teachers responded to questionnaires on their language development, socioeconomic level, and academic performance. The auditory skills of figure-ground, association between auditory and visual stimuli, figure-ground for linguistic sounds, binaural integration, temporal ordering, and temporal resolution were assessed using the following auditory behavioral instruments: Pediatric Speech Intelligibility (PSI) test, Dichotic Digits Test (DDT), Auditec® Frequency Pattern Test (FPT), and Gaps-in-Noise (GIN) test. Receptive vocabulary and reading comprehension were evaluated using the TVF-usp and PROLEC tests, respectively. Results: Statistically significant differences were observed between the socioeconomic level of students in both schools. Although the results obtained in the applied tests were within the reference values in both groups, there was a tendency to higher scores in the PrivG. Differences between the groups were also verified in the DDT and FPT. Values similar to normality were obtained in the temporal resolution and reading comprehension assessments. On the vocabulary test, most school children in the PrivG were concentrated in the ‘high’ and ‘middle’ categories, whereas those in the PubG were in the ‘middle’ and ‘low’ categories. Conclusion: There are differences in performance between students from private and public schools. Public school children presented right ear advantage in the dichotic task, whereas private school children showed more efficient mechanisms and strategies regarding auditory stimuli for the tasks of binaural integration, temporal ordering, and interhemispheric transfer. Temporal resolution reached values expected for the adult population in both groups. Better vocabulary performance was observed in the most economically favored children. Elementary School (5th grade) students from both school networks present developed reading.

Predicting educational achievement from genomic measures and socioeconomic status

The two best predictors of children's educational achievement available from birth are parents’ socioeconomic status (SES) and, recently, children's inherited DNA differences that can be aggregated in genome‐wide polygenic scores (GPS). Here, we chart for the first time the developmental interplay between these two predictors of educational achievement at ages 7, 11, 14 and 16 in a sample of almost 5,000 UK school children. We show that the prediction of educational achievement from both GPS and SES increases steadily throughout the school years. Using latent growth curve models, we find that GPS and SES not only predict educational achievement in the first grade but they also account for systematic changes in achievement across the school years. At the end of compulsory education at age 16, GPS and SES, respectively, predict 14% and 23% of the variance of educational achievement. Analyses of the extremes of GPS and SES highlight their influence and interplay: In children who have high GPS and come from high SES families, 77% go to university, whereas 21% of children with low GPS and from low SES backgrounds attend university. We find that the associations of GPS and SES with educational achievement are primarily additive, suggesting that their joint influence is particularly dramatic for children at the extreme ends of the distribution.

Monozygotic twin differences in school performance are stable and systematic

School performance is one of the most stable and heritable psychological characteristics. Notwithstanding, monozygotic twins (MZ), who have identical genotypes, differ in school performance. These MZ differences result from non-shared environments that do not contribute to the similarity within twin pairs. Because to date few non-shared environmental factors have been reliably associated with MZ differences in school performance, they are thought to be idiosyncratic and due to chance, suggesting that the effect of non-shared environments on MZ differences are age- and trait-specific. In a sample of 2768 MZ twin pairs, we found first that MZ differences in school performance were moderately stable from age 12 through 16, with differences at the ages 12 and 14 accounting for 20% of the variance in MZ differences at age 16. Second, MZ differences in school performance correlated positively with MZ differences across 16 learning-related variables, including measures of intelligence, personality and school attitudes, with the twin who scored higher on one also scoring higher on the other measures. Finally, MZ differences in the 16 learning-related variables accounted for 22% of the variance in MZ differences in school performance at age 16. These findings suggest that, unlike for other psychological domains, non-shared environmental factors affect school performance in systematic ways that have long-term and generalist influence. Our findings should motivate the search for non-shared environmental factors responsible for the stable and systematic effects on children's differences in school performance. A video abstract of this article can be viewed at: https://youtu.be/0bw2Fl_HGq0.

Experimental data required to support second medical use claims

The timing of filing a new patent application always requires a judgment call to be made between securing the earliest filing date and waiting to collect enough data to ensure the claims are fully supported and enabled across their scope. In addition, it is important to ensure that the application is drafted in such a way that it is suitable for filing in various jurisdictions. The case law we have considered for the sufficiency/enablement of second medical use claims in Europe, the USA and Australia makes it clear that experimental results should be included in the application at filing, and that the results must demonstrate that the claimed pharmaceutical product could be reasonably expected to treat the claimed indication.