title: Academic achievement of children and adolescents with oral clefts.
abstract: OBJECTIVE
  Previous studies of academic achievement of children with oral clefts have mostly relied on small, clinic-based samples prone to ascertainment bias. In the first study in the United States to use a population-based sample with direct assessment, we evaluated the academic achievement of children with oral clefts relative to their classmates.
  
  
  METHODS
  Children born with isolated oral clefts in Iowa from 1983 to 2003 were identified from the Iowa Registry for Congenital and Inherited Disorders and matched to unaffected classmates by gender, school/school district, and month and year of birth. Academic achievement was assessed by using standardized tests of academic progress developed by the Iowa Testing Programs. Iowa Testing Programs data were linked to birth certificates for all children. Regression models controlled for household demographic and socioeconomic factors. The analytical sample included 588 children with clefts contributing 3735 child-grade observations and 1874 classmates contributing 13 159 child-grade observations.
  
  
  RESULTS
  Children with oral clefts had lower scores than their classmates across all domains and school levels, with a 5-percentile difference in the overall composite score. Children with clefts were approximately one-half grade level behind their classmates and had higher rates of academic underachievement and use of special education services by 8 percentage points. Group differences were slightly lower but remained large and significant after adjusting for many background characteristics.
  
  
  CONCLUSIONS
  Children with oral clefts underperformed across all academic areas and grade levels compared with their classmates. The results support a model of early testing and intervention among affected children to identify and reduce academic deficits.
authors.affiliation: Departments of Health Management and Policy, and National Bureau of Economic Research, Cambridge, Massachusetts; and george-wehby@uiowa.edu.
authors.forename: George L
authors.initials: GL
authors.lastname: Wehby
authors.affiliation: Child Psychiatry at Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Brent
authors.initials: B
authors.lastname: Collet
authors.affiliation: Iowa Testing Programs; and.
authors.forename: Sheila
authors.initials: S
authors.lastname: Barron
authors.affiliation: Epidemiology, College of Public Health;
authors.forename: Paul A
authors.initials: PA
authors.lastname: Romitti
authors.affiliation: Psychological and Quantitative Foundations, University of Iowa, Iowa City, Iowa;
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Ansley
authors.affiliation: Child Psychiatry at Seattle Children's Hospital and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Speltz
mesh_terms: D000124:Achievement; D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002971:Cleft Lip / Q000453:epidemiology* / Q000523:psychology*; D002972:Cleft Palate / Q000453:epidemiology* / Q000523:psychology*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007484:Iowa; D008297:Male; D012016:Reference Values; D012042:Registries
keywords: academic achievement; academic testing; cleft lip; cleft palate; learning disability
references.citation: Pediatrics. 2007 Feb;119 Suppl 1:S77-83
references.pmid: 17272589
references.citation: Clin Genet. 2002 Apr;61(4):248-56
references.pmid: 12030886
references.citation: Arch Pediatr Adolesc Med. 2007 Aug;161(8):753-8
references.pmid: 17679656
references.citation: Cleft Palate Craniofac J. 2007 May;44(3):321-8
references.pmid: 17477749
references.citation: Cleft Palate Craniofac J. 2012 Jul;49(4):387-96
references.pmid: 21905907
references.citation: Orthod Craniofac Res. 2007 Aug;10(3):138-48
references.pmid: 17651130
references.citation: Child Neuropsychol. 2009 Sep;15(5):471-84
references.pmid: 19184778
references.citation: Pediatrics. 2011 Jun;127(6):1034-42
references.pmid: 21606152
references.citation: Birth Defects Res A Clin Mol Teratol. 2010 Dec;88(12):1008-16
references.pmid: 20878909
references.citation: Cleft Palate Craniofac J. 2012 Mar;49(2):153-9
references.pmid: 21214320
references.citation: JAMA. 2004 Apr 28;291(16):2007-12
references.pmid: 15113820
references.citation: Birth Defects Res A Clin Mol Teratol. 2008 Mar;82(3):147-54
references.pmid: 18183625
references.citation: J Pediatr Psychol. 2000 Apr-May;25(3):185-90
references.pmid: 10780146
references.citation: Cleft Palate Craniofac J. 1995 Mar;32(2):99-103
references.pmid: 7748881
references.citation: Cleft Palate Craniofac J. 2005 Sep;42(5):565-9
references.pmid: 16149841
references.citation: Cleft Palate Craniofac J. 1998 Mar;35(2):127-31
references.pmid: 9527309
references.citation: J Clin Child Adolesc Psychol. 2005 Sep;34(3):506-22
references.pmid: 16083392
references.citation: Laryngoscope. 2004 Nov;114(11 Pt 3 Suppl 105):1-26
references.pmid: 15514559
references.citation: Cleft Palate Craniofac J. 2003 Mar;40(2):154-7
references.pmid: 12605520
references.citation: Cleft Palate Craniofac J. 1999 Jan;36(1):3-11
references.pmid: 10067755
references.citation: Cleft Palate Craniofac J. 2010 May;47(3):284-92
references.pmid: 20426677
references.citation: J Pediatr Psychol. 2010 Mar;35(2):199-208
references.pmid: 19509183