Perception of difficulty and glucose control: Effects on academic performance in youth with type I diabetes

Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders

Importance

Research shows that children and adolescents with type 1 diabetes (T1D), compared with their peers without diabetes, have a greater risk of psychiatric disorders. However, no study has comprehensively examined whether having psychiatric disorders is associated with educational outcomes in children and adolescents with T1D.

Objective

To investigate educational outcomes in children and adolescents with T1D with and without psychiatric disorders.

Design, Setting, and Participants

This cohort study used data from multiple Swedish registers. The main study cohort included individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed up from birth through December 31, 2013. Data analyses were conducted from March 1 to June 30, 2022.

Exposures

Type 1 diabetes and psychiatric disorders (including neurodevelopmental disorders, depression, anxiety disorders, eating disorders, bipolar disorder, psychotic disorder, and substance misuse) diagnosed before 16 years of age.

Main Outcomes and Measures

Achieving educational milestones (completing compulsory school [primary and lower secondary education], being eligible to and finishing upper secondary school, and starting and finishing university) and compulsory school performances.

Results

Of 2 454 862 individuals (51.3% male), 13 294 (0.5%; 53.9% male) were diagnosed with T1D (median [IQR] age at diagnosis, 9.5 [6.0-12.5] years), among whom 1012 (7.6%) also had at least 1 psychiatric disorder. Compared with healthy individuals (without T1D and psychiatric disorders), individuals with T1D alone had slightly lower odds of achieving the examined educational milestones. However, those with both T1D and any psychiatric disorder had much lower odds of achieving milestones, including completing compulsory school (odds ratio [OR], 0.17; 95% CI, 0.13-0.21), being eligible for (OR, 0.25; 95% CI, 0.21-0.30) and finishing (OR, 0.19; 95% CI, 0.14-0.26) upper secondary school, and starting (OR, 0.36; 95% CI, 0.29-0.46) and finishing (OR, 0.30; 95% CI, 0.20-0.47) university. They also showed lower grade point averages for compulsory school subjects. These findings remained similar in sibling comparison analyses, suggesting independence from familial confounding.

Conclusions and Relevance

In this cohort study of Swedish-born children and adolescents, those with T1D alone had minor difficulties with their educational outcomes, whereas those with both T1D and psychiatric disorders had universal long-term educational underachievement. These findings highlight the importance of identifying psychiatric disorders in pediatric patients with T1D and the need for targeted educational intervention and support to minimize the education gap between the affected children and their peers.

Association Between Malocclusion and Academic Performance Among Mongolian Adolescents

Objective: Malocclusion has been reported to affect the daily lives of schoolchildren adversely, but little is known regarding the association between malocclusion and academic performance. We aimed to investigate the association between malocclusion and academic performance among adolescents in Mongolia.

Methods: We conducted a cross-sectional study of 767 students aged 7–16 years from two public schools in Ulaanbaatar, Mongolia. Three orthodontists evaluated the need for malocclusion treatment in the participants and determined the type of malocclusion using the Index of Orthodontic Treatment Need and dental casts. The academic scores of study participants in 20 subjects were provided by their schools. Z-scores within subjects were calculated and aggregated into both overall and in six groups of subject categories comprised of mathematics, science, social science, language, arts, and physical education. A multiple linear regression analysis was performed to determine the association between malocclusion, malocclusion type, and academic score adjusted for gender, age, school, and family income.

Results: Of the 767 students, 32.6% had malocclusion, and dental crowding was the most prevalent type (162 cases, 21.1%). Malocclusion was not significantly associated with the z-score of overall academic score [coefficient: 0.04, 95% confidence interval (CI): −0.11 to 0.19]; however, dental crowding was significantly associated with the overall academic score (coefficient: −0.19, 95% CI: −0.35 to −0.03), after adjusting for covariates. Other types of malocclusion were not associated with academic scores. Among the six subject categories, arts (coefficient: −0.20, 95% CI: −0.36 to −0.04) and physical education (coefficient: −0.24, 95% CI: −0.42 to −0.07) were significantly associated with dental crowding.

Conclusions: Schoolchildren in Mongolia with dental crowding may be prone to poor academic performance, particularly in arts and physical education classes. Further randomized controlled trials are needed to determine whether the treatment of crowding boosts academic performance.

Benefit finding among parents of young children with type 1 diabetes

Benefit finding, perceived positive effects of adversity, has been associated with psychological well-being in people with chronic illnesses and with better adherence for adolescents with type 1 diabetes (T1D). Our qualitative research with parents of young children (< 6 years old) with T1D indicated that benefit finding (BF) is a common parental coping mechanism, but no tools exist to measure BF in parents. We determined psychometric properties of the Diabetes Benefit Finding Scale for Parents (DBFS-P), a 16-item questionnaire adapted from the validated adolescent version. Parents of young children with T1D (n = 172) were participants in a randomized trial of an online intervention. We examined the DBFS-P factor structure through principal component analysis (PCA); internal consistency through Cronbach's alpha; convergent validity via bivariate correlations between the DBFS-P and measures of parental depression, anxiety, T1D self-efficacy, and hypoglycemia fear; and discriminant validity via bivariate correlations between the DBFS-P and measures of parental somatization and child behavior problems. PCA revealed one factor (56.47% variance) with Cronbach's α = 0.95. Convergent validity of the DBFS-P was supported by significant correlations with parental depression (r = -0.35, P < 0.001), anxiety (r = -0.20, P = 0.008), T1D self-efficacy (r = 0.36, P < 0.001), and hypoglycemia fear (r = 0.27, P < 0.001). Non-significant correlations with parental somatization (r = -0.06, P = 0.42) and child behavior problems (r = -0.12, P = 0.14) support its discriminant validity. The DBFS-P demonstrated good psychometric properties as a tool for assessing BF among caregivers.

Health as a Predictor of Students' Academic Achievement: A 3-Level Longitudinal Study of Finnish Adolescents

BACKGROUND

Studies have shown a relationship between students' health and their academic achievements, but whether health of classmates and schoolmates impacts individual students' school achievement is less known. We studied these effects on students in lower secondary school in Finland.

METHODS

Students (seventh grade, age 12-13 years, N = 7779, 123 schools, 565 classes) participated in a classroom survey measuring health (externalizing and internalizing problems, daily health complaints, and long-term illness) and academic achievement. Academic achievement when leaving school (15-16 years) was obtained from the Finnish national application register on upper secondary education. Three-level (student, class, and school) multilevel regression analyses were executed.

RESULTS

All health variables predicted academic achievement at leaving school at the student level and externalizing and internalizing problems at the class level; better health predicted better achievement. Students' health at the school level was not related to academic achievement. The effect of class-level health on academic achievement was as strong as the effect of student-level health.

CONCLUSION

Both student and classmates' health at the beginning of lower secondary school contribute to academic achievement when leaving school.