Chronic Health Conditions and Student Performance at School
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Chronic Health Conditions and Student Performance at SchoolHoward Taras, William Potts-Datema
ABSTRACT: To review the state of research on the association between common chronic health conditions and academic outcomes,the authors reviewed published studies investigating the association of school attendance, cognitive ability, and achievement witha number of chronic diseases. Tables with brief descriptions of each studys research methods and outcomes are included.Research reveals evidence that diabetes, sickle cell anemia, and epilepsy affect student achievement and ability. Levels of academicdeficiency and specific areas of cognitive impairment are not as well understood. Many chronic conditions are not well researched.Suggestions for further research and recommendations for educators and health practitioners are provided. (J Sch Health.2005;75(7):255-266)
Health professionals frequently remind educators ofthe correlation between childrens health and aca-demic potential. That generalization is not often accompa-nied by a discussion of specific health conditions or factorsand more rarely accompanied by evidence. Moreover, thecharacteristics of impaired performance or ability second-ary to poor health are commonly not understood.
To clarify and quantify the relationship between healthand child performance and ability at school, the NationalCoordinating Committee on School Health and Safety,comprising representatives of federal departments andnational nongovernmental organizations, reviewed thestate of this research. The project involves conducting lit-erature searches of peer-reviewed, published research re-porting on the relationship between students health andtheir performance in school.
This article summarizes what is known through pub-lished research about the association of academic out-comes with diabetes, sickle cell anemia, seizure disorders,and other chronic diseases. Connections between schoolperformance and student asthma and student obesity, the2 most common chronic conditions affecting school-agedchildren, are summarized in separate articles.
The criteria for an article to be selected for reviewwere as follows: (1) subjects of study were school-agedchildren (age 5-18 years) and (2) the research included atleast 1 of the following outcomesschool attendance,academic achievement, a measure of cognitive ability(such as general intelligence, memory), and attention.Studies were identified using MedLine and similar Inter-net-based searches. If a full article could not be retrieved,studies with detailed abstracts were included. Many stud-ies cited in this review reported major outcome measuresother than those pertinent to the objectives of this project.These alternative outcomes may not be described or areonly briefly mentioned.
A recent survey of teachers and other school professio-nals in 23 elementary schools elicited their attitudes toward
and knowledge of students in their classes with 6 chronicconditions: AIDS, asthma, congenital heart disease, diabe-tes mellitus, epilepsy, and leukemia.1 There was a positiveperception of children with chronic conditions in the class-room. Two thirds of respondents expected students withAIDS to have academic difficulties affecting achievement.Academic difficulties were expected among 51% of re-spondents for students with leukemia, 41% of respondentsfor students with epilepsy, 34% for those with congenitalheart disease, and 17% and 14% for those with diabetesand asthma, respectively. Reservations teachers had aboutthese students were not based on their academic difficultiesbut on the teachers perception that they themselves lackboth the time and medical expertise to adequately care forthese students with chronic conditions at school. One fourthof educators felt that children with congenital heart diseasemight die in the classroom. School staff are eager to learnmore about chronic diseases, and most respondents inthis survey requested additional information on theseconditions.
DIABETESPeople with diabetes have a shortage of insulin or
a decreased ability to use insulin, a hormone that allowsglucose (sugar) to enter cells and be converted to energy.There are 2 main types of diabetes. Type 1 most often ap-pears during childhood or adolescence. Type 2 diabetes,which is linked to obesity and physical inactivity, ac-counts for 90% to 95% of diabetes cases and most oftenappears among people older than 40 years. With the onsetof the obesity epidemic, however, type 2 is being diag-nosed in higher numbers of children and teenagers. Inaddition to the recent and publicized increase in type 2diabetes among youth, the incidence of childhood type 1diabetes also has increased, although the origins of thisincrease are poorly understood. In the past century inEurope and North America, more than a 350-fold increasehas occurred in incidence rate of type 1 diabetes.2
Fifteen published articles (all published since 1994)were found and reviewed, each describing associationsbetween childhood diabetes (type 1, primarily) and stu-dent attendance, cognitive ability, or academic achieve-ment (Table 1). Most, but not all articles, demonstrate anassociation between poor cognitive functioning and earlyonset of diabetes (younger than 5 years) and/or a history ofsevere hypoglycemic episodes (ie, dangerously low bloodsugar levels, sometimes resulting in a seizure). The specificnature of the psychoeducational deficit varies from study to
Howard Taras, MD, Professor, (email@example.com), Division of CommunityPediatrics, University of California, San Diego, Gilman Drive #0927,La Jolla, CA 92093-0927; and William Potts-Datema, MS, Director,(firstname.lastname@example.org), Partnerships for Childrens Health, HarvardSchool of Public Health, 677 Huntington Ave, 7th Floor, Boston, MA 02115.This article is 1 of 6 articles that are part of a project of the National Coor-dinating Committee on School Health and Safety (NCCSHS). This NCCSHSproject was funded by the US Department of Health and Human Services,Department of Education, and US Department of Agriculture. Opinions ex-pressed in this article are not necessarily shared by these federal agenciesor other institutions that comprise NCCSHS membership.
Journal ofSchool Health d September 2005, Vol. 75, No.7 d 255
256 d Journal of School Health d September 2005, Vol. 75, No.7
Journal ofSchool Health d September 2005, Vol. 75, No.7 d 257