Children, adolescents with mental disorders may experience lower educational achievement

Almost all mental disorders among children or adolescents appeared associated with a lower likelihood of taking the final examination at the end of ninth grade, according to results of a population-based cohort study conducted in Denmark and published in JAMA Psychiatry.

Individuals with specific disorders were more likely to achieve lower mean grades on the examination, and compared with boys, girls with certain mental disorders seemed to have relatively more impairment.

“Children and adolescents with mental health problems often struggle to succeed at school,” Søren Dalsgaard, MD, PhD, of National Centre for Register-Based Research at Aarhus University in Denmark, and colleagues wrote. “Compared with their peers, they have more missed school days, their suspension and expulsion rates are [three] times higher, they are more likely to drop out of high school and they have lower attendance in final examinations and lower test scores. Inattention, anxiety, depressed mood or psychotic experiences can interfere with learning while in the classroom and can result in difficulties with finishing homework and lower performance during tests.”

The researchers noted that adverse effect of pharmacotherapy, such as antipsychotics, also may explain educational difficulties. Furthermore, previous studies have shown genetic associations between mental disorders and educational, reading and spelling abilities, as well as intelligence.

Dalsgaard and colleagues aimed to compare educational achievements at the final examination of compulsory schooling in Denmark between those with and without a mental disorder. They obtained data from nationwide registers, including the Danish Civil Registration System. They analyzed data of two cohorts — all children who were born in Denmark between January 1988 and July 1, 1999, and who were alive at age 17 years (n = 629,622), as well as all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 2002 and December 2016 (n = 542,500). As exposures, the investigators used clinical diagnosis by a psychiatrist of any mental disorder or one of 29 specific mental disorders before age 16 years. Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in standardized mean grade differences (SDs) served as the main outcomes and measures.

Of the more than 600,000 individuals analyzed, 523,312 (83%) took the final examination before age 17 years and 38,001 (6%) had a mental disorder before that age. Among the individuals who took the final examination on both Danish and mathematics subjects, the mean age was 16.1 years for girls and 16.2 years for boys. Among the 22,158 boys and 15,843 girls with a mental disorder, a lower proportion took the final examination (SD = 0.52; 95% CI, 0.52-0.53) compared with those without a mental disorder (SD = 0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of girls (SD = –0.24; 95% CI, –0.25 to –0.22) less than the grades of their male peers (SD = –0.3; 95% CI, –0.32 to –0.28) when compared with same-sex individuals without mental disorders.

The researchers reported associations between most specific mental disorders and statistically significantly lower mean grades. Intellectual disability was associated with the lowest grade among girls (SD = –1.07; 95% CI, –1.23 to –0.91) and boys (SD = –1.03; 95% CI, –1.17 to –0.89). Girls and boys with anorexia nervosa achieved statistically significantly higher grades on the final examination (SD = 0.38; 95% CI, 0.32-0.44; and 0.31; 95% CI, 0.11-0.52) compared with their peers without this disorder. Girls attained relatively lower SDs compared with their male counterparts for anxiety, attachment, ADHD and other developmental disorders.

“We believe that these findings emphasize the need to provide additional support in school for children and adolescents with mental disorders,” the researchers wrote.

In a related editorial, Catharina A. Hartman, PhD, of the Interdisciplinary Center Psychopathology and Emotion Regulation at University Medical Center Groningen in the Netherlands, highlighted the future research potential buoyed by the current study.

“The knowledge base built up by large and comprehensive studies such as those from Dalsgaard and colleagues not only creates awareness of the magnitude and severity of the situation but also forms the basis for research into the causal processes involved in onset and course,” Hartman wrote. “This will appropriately target prevention and intervention strategies, which are otherwise likely to fail. Ultimately, this will improve the often-difficult life trajectories of individuals with mental health problems in childhood.” – by Joe Gramigna

Disclosures: Dalsgaard reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Hartman reports no relevant financial disclosures.