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14-02-2012 | Psychology | Article

Adolescents with IBD have difficulty functioning in school


Free abstract

MedWire News: Adolescents with inflammatory bowel disease (IBD) have trouble functioning in school, being more likely to miss lessons, to repeat a year of school, and to need specific help with schooling, and less likely to enjoy school or achieve good grades than other children, say researchers.

The study findings, which are published in the Journal of Developmental and Behavioral Pediatrics, demonstrate that demographic and psychosocial factors are more likely to be responsible for these difficulties than disease-related factors.

Based on previous research suggesting that IBD may negatively impact on school life, Laura Mackner (Nationwide Children's Hospital, Columbus, Ohio, USA) and colleagues assessed the level of school functioning in 92 adolescents between the age of 11 and 17 years, 50 of whom had IBD and 42 who did not have IBD (healthy controls).

"Both IBD and its treatment have the potential to disrupt school functioning," explained co-author Wallace Crandall, also from Nationwide Children's Hospital, in a press statement.

"Primary symptoms of IBD include abdominal pain, fatigue and diarrhea. Corticosteroids affect learning and memory and intravenous medication requires hours in an infusion clinic."

School functioning was measured using a combination of factors including number of absences, school achievement, retention of grades, special education requirement, and school-related quality of life (QoL; evaluated as part of the Pediatric Quality of Life Inventory). Participants and parents completed questionnaires evaluating psychosocial and school functioning, and report cards and absence information were obtained from schools.

Mackner and team found that participants with IBD had poorer school functioning than healthy controls in all areas tested.

Specifically, absences were higher (mean 12.45 vs 6.92 per year), grade point average was lower (mean 3.08 vs 3.38), school QoL was lower (mean 68.56 vs 75.20 points), special education requirement was higher (10 vs 4%), and the likelihood of having repeated a grade was also higher (12 vs 11%) in young people with IBD versus controls.

In adolescents with IBD, a tendency to internalize problems (as identified from psychosocial questionnaire answers - Child Behavior Checklist) predicted poor school attendance.

"Youth with IBD are at increased risk for depression, so the finding that internalizing problems are associated with school absence is a particular concern with important implications," said Mackner.

The team also found that family income and externalizing problems were associated with grade point average, and parent marital status and presence of somatic complaints were linked to school QoL.

Notably, IBD disease-related factors did not significantly predict school functioning. The authors concede that the IBD patients in this study were mostly in remission or had mild symptoms and say that it is uncertain whether the same results would have been obtained if the children in the IBD group had more severe disease.

"Longitudinal research is needed to investigate whether school difficulty is associated with longer term effects on future educational and occupational outcomes for these children," said Crandall.

By Helen Albert

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