Education outcomes worsen for kids with neurodevelopmental multimorbidity


More than 1 condition can have an impact on health outcomes. A new investigation examines how multimorbidity can impact educational outcomes.

For some children, attention-deficit/hyperactivity disorder or autism spectrum disorder may be the only neurodevelopmental condition that they have, but many children have both as well as others. Multimorbidity has been researched in adults, but not so much in children. An investigation in PLoS Medicine looks at the both the prevalence of multimorbidity and the educational outcomes of children with more than 1 neurodevelopmental condition in comparison to peers.1

The investigators linked 6 Scotland-wide databases to find children with neurodevelopmental conditions. The matching across the databases was a mix of deterministic and probabilistic. Only singleton children were included because of the difficulty of matching to the correct child from a multiple birth. The study’s outcomes included annual number of absences, annual number of suspensions or expulsions due to challenging or disruptive behavior, academic attainment, and unemployment after school. Academic attainment and unemployment were restricted to children who left school during the study period.

The study included 766,244 children with an average age of 10.9 years. Most of the children were of white ethnicity. Neurodevelopmental multimorbidity was found in 4789 children and autism spectrum disorder and intellectual disability was the most common combination. Following adjustment for sociodemographic and maternal factors, multimorbidity was linked with increased school absenteeism, exclusion, poorer exam attainment, and unemployment. Additionally, a significant dose relationship was seen between the number of conditions and the last 3 outcomes. When compared to the children who had no neurodevelopmental conditions, children with 1 condition as well as children with 2 or more conditions had increased absenteeism(1 condition adjusted incidence rate ratio [IRR] 1.28, 95% CI 1.27–1.30, p < 0.001 and 2 or more conditions adjusted IRR 1.23, 95% CI 1.20–1.28, p < 0.001), greater exclusion (adjusted IRR 2.37, 95% CI 2.25–2.48, p < 0.001 and adjusted IRR 3.04, 95% CI 2.74–3.38, p < 0.001), poorer attainment (adjusted odds ratio [OR] 3.92, 95% CI 3.63–4.23, p < 0.001 and adjusted OR 12.07, 95% CI 9.15–15.94, p < 0.001), and increased unemployment (adjusted OR 1.57, 95% CI 1.49–1.66, p < 0.001 and adjusted OR 2.11, 95% CI 1.83–2.45, p < 0.001). These links remained even after adjusting for comorbid physical conditions and additional support need. The strongest driver for absenteeism was coexisting depression and attention-deficit/hyperactivity disorder for exclusion.

The researchers concluded that having clinical practice and training focused on single conditions could be a disadvantage for children who have neurodevelopmental multimorbidity.


1. Fleming M, Salim E, Mackay D. Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study. PLoS Med. October 13, 2020. Epub ahead of print. doi:10.1371/journal.pmed.1003290

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