UK Millennium Cohort Study: School and the disabled child

Quite recently the BBC News online ran with the headline: "Disabled children's behaviour 'deteriorates at school'". The story revolved around the findings reported by Rebecca Fauth and colleagues [1] (open-access) looking at "the extent to which the associations between disability and behaviour are linked to children’s developmental stage and thus may be ‘grown out of’ as children enter school and move out of the early years". I should add that, at the time of writing, the Fauth paper is described as a 'working paper' and further "Citation of such a paper should account for its provisional character". So noted.

But why Earth, Jor-El? They're primitives...

With apologies for all the quotations included in this entry, participants for this trial were drawn from the UK Millennium Cohort Study (MCS) [2] which has previously reported on the topic of autism [3] - "Pre-diagnostic data showed early health problems differentiated children later diagnosed with autism from non-diagnosed peers" - Mmm.

In the Fauth paper it included over 6000 UK children covering various ages at different times over the course of the study (referred to as 'sweeps'). Children without reported disability were compared against 3 primary groups defined as 'disabled':

• Children with developmental delay (DD) at 9 months of age. This was assessed via "a set of 8 questions... that were taken from the Denver Developmental Screening Test" and "five items from an UK adaptation of the MacArthur Communicative Development Inventories (CDI) were used to identify early communicative gestures".
• Children with a "Long-standing limiting illness [LSLI] at 3, 5 or 7 years". LSLI was defined "if they had an LSLI at one or more of the occasions it was asked between age 3 and age 7" and included various conditions covering 'mental health' and physical health (asthma, type 1 diabetes and vision impairment).
• Children with Special Educational Needs (SEN) at age 7. Those familiar with the UK system will probably already know about SEN, but for those that don't, it covers "those children who need additional support with their learning" (see here). Further: "SEN may relate to learning difficulties or impairments such as hearing loss, ADHD or dyslexia".

Researchers tracked participants looking at various measures covering areas of "children's emotional, relationship and behavioural issues at the ages of three, five and seven" according to the BBC report. Fauth and colleagues list the dependent variables as being derived from "the four ‘problem’ subsets of the parent-reported Strengths and Difficulties Questionnaire (SDQ)". They also took into account various other factors based on family background and constitution, the parent-child relationship (including discipline practices) and child characteristics.

Based on some nifty statistical modelling, the authors reported on a few key points:

• So: "in their early preschool years disabled children do suffer from more challenging expressions of behaviour". 
• With some caveats: "disabled children exhibit a divergent trajectory from the ‘average’ child, showing increases over time in peer problems, hyperactivity and emotional problems, but not for conduct problems".
• Also: "family and individual characteristics that are associated with both disability and behaviour (such as poverty, family structure, cognitive ability and home environment) mediate the effects of disability in these instances".
• The authors talk about sex differences in their results: "overall girls face lower levels of peer, conduct and hyperactivity behavioural problems across the early years than boys". This is perhaps not an unexpected result as any parent with both boys and girls will perhaps tell you. But: "disabled boys consistently demonstrated more hyperactive problems than non disabled boys, and that these differences grew over time for boys with LSLI and SEN". Additionally: "The differences between disabled and non-disabled children is much greater for boys than for girls, and this divergence between disabled and non-disabled boys grows more over time than it does for girls".
• Parenting styles also get a mention in the results: "harsh discipline being consistently associated with higher levels of problem behaviours, and parent-child closeness being linked to lower rates of problem behaviours". With disability in mind however, the authors saw: "very little evidence of parenting moderating the relationship between disability and problem behaviours, either at age 3 or over time".

I should also add that when it came to looking at developmental delay (DD) the authors noted: "the developmental trajectories of children identified as DD did not diverge from those without DD" although measurement of peer and hyperactivity issues for example, did still not 'close the gap' compared with non-DD participants.

The authors conclude: "Child behavioural difficulties can have far reaching consequences and hence, without appropriate support or intervention, young disabled children may face an accumulation of adverse consequences that serve to compromise their well-being in adolescence and adulthood".

I'm sure you can appreciate how important this work is in terms of both how disability impacts on childhood and what strategies might be put in place to reduce some of the more adverse effects of such issues and lessen any inequality as a result. I note for example, that the BBC write-up of this research has given quite a lot of weight with regards to bullying and the notion that schools should adopt "more stringent anti-bullying strategies for those identified as different" as a result of the findings. I would very much agree with this position; with the caveat of ensuring that children with disability are not further plunged into the 'victim' label as a result of any strategies. This can sometimes itself have consequences for things like future independence and self-esteem; thus helping individuals to help themselves - instilling confidence and resilience and building up feelings of self-worth - is another strand to any discussions (and I have a few ideas on that without making any sweeping generalisations). I'm also wondering whether the debate on home-schooling might also come into play here too?

I'd finally also like to pass some comment about the issue of parenting styles discussed in the findings. Although no large effect appeared to be observed from parenting style and problem behaviours in those with disability, the more general association between harsh parenting style and hyperactive behaviours for example, offers a fascinating opportunity and potentially offers some, more general lessons on child development and rearing. I might add that the parenting style - disability non-event - "does not have much role in modifying the specific trajectories of problem behaviours associated with disability" - might also carrying some lessons for particular conditions like autism for example too (see here).

Now, how about looking at other potential mediators of behaviour such as adequate sleep [4], regular exercise and good nutrition [5] (including a possible role for supplementation)? Too much...?

Music to close. Love Me Like You from the Magic Numbers (although my brood prefer their cameo performance in the Harry Hill Movie...)

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[1] Fauth R. et al. Convergence or divergence? A longitudinal analysis of behaviour problems among disabled and non-disabled children aged 3 to 7 in England. Department of Quantitative Social Science. Institute of Education, University of London. Working Paper No. 14-13. Sept 2014.

[2] Connelly R. & Platt L. Cohort Profile: UK Millennium Cohort Study (MCS). Int J Epidemiol. 2014 Feb 17.

[3] Dillenburger K. et al. he Millennium child with autism: Early childhood trajectories for health, education and economic wellbeing. Dev Neurorehabil. 2014 Oct 7:1-10.

[4] Lee HK. et al. Sleep and cognitive problems in patients with attention-deficit hyperactivity disorder. Neuropsychiatr Dis Treat. 2014 Sep 17;10:1799-805.

[5] Bellisle F. Effects of diet on behaviour and cognition in children. Br J Nutr. 2004 Oct;92 Suppl 2:S227-32.

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Connelly R, & Platt L (2014). Cohort Profile: UK Millennium Cohort Study (MCS). International journal of epidemiology PMID: 24550246