Academic achievement of children and adolescents with oral clefts

描述(申请人提供)：唇腭裂(CL-P)是常见的出生缺陷，发生在大约1/500到1/2500的新生儿中。无其他重大出生缺陷或综合征的非综合征(NS)形式是最常见的，通过增加死亡和某些慢性病的风险，对受影响个人的健康造成巨大的早期和长期不利影响。NSCL-P还可能降低教育、心理社会和经济成就。鉴于教育对这些结果的重要影响，需要了解NSCL-P对教育成绩的影响，以了解NSCL-P影响健康、心理社会和经济表现的途径。此外，准确估计NSCL-P的影响以及这些影响如何因社会经济、人口和健康背景而变化，对于确定需求和制定具有成本效益的政策和干预措施以改善受影响个人的福祉至关重要。然而，关于NSCL-P对受影响个人的教育成就的影响，仍有许多未知之处。一些研究报告称，在生命早期和整个成年期，这对认知表现和/或教育成就都有不利影响。然而，这些研究受到以临床为基础的小样本、缺乏适当的对照组以及忽略随时间变化的横断面设计的限制。此外，这些研究中没有一项确定可能与NSCL-P对教育成就的影响相互作用并改变其影响的社会经济、人口或健康因素。这项拟议的研究将确定NS CL-P对患有口裂的儿童和青少年的教育成就的影响，并评估这些影响如何因社会经济、人口和健康背景而变化。这项研究具有很高的创新性，采用独特的、现有的数据基础设施来实现研究的具体目标，并解决了以前研究的几个局限性。我们将研究爱荷华州通过爱荷华州先天性和遗传性疾病登记处(IRCID)确定的口腔唇裂患者的大量人群样本，以及来自国家出生缺陷和预防研究(NBDPS)的包括兄弟姐妹、同学和未受影响的儿童在内的多个对照组。与以前的研究相比，这种多控制组方法提供了显著的方法学优势。我们使用爱荷华州大学开发和维护的客观标准化爱荷华州学校考试来衡量教育成绩，该考试具有很高的信度和效度。我们将评估阅读、数学、语言和科学的分数以及综合分数。我们还将把出生记录和NBDPS调查数据联系起来，了解孕期的健康、社会经济和人口特征以及风险因素。此外，我们还采用纵向设计研究了NSCL-P对学业成就的影响及其随年龄的变化。这项研究将增加关于NSCL-P对教育成就的影响以及如何改善受影响个人的长期结果的重要知识。

DESCRIPTION (provided by applicant): Cleft lip and/or palate (CL-P) are common birth defects occurring in about 1/500 to 1/2500 births. Nonsyndromic (NS) forms occurring without other major birth defects or syndromes are the most common and impose large early and long-term adverse effects on the health of affected individuals by increasing the risks for mortality and certain chronic conditions. NSCL-P may also reduce educational, psychosocial, and economic achievement. Understanding the NSCL-P effects on educational achievement is needed for understanding the pathways through which NSCL-P affects health and psychosocial and economic performance given the important effects of education on these outcomes. Furthermore, obtaining accurate estimates of the NSCL-P effects and how they vary by socioeconomic, demographic and health backgrounds is essential for identifying needs and developing cost-effective policies and interventions to improve the wellbeing of affected individuals. However, much remains unknown about the NSCL-P effects on the educational achievement of affected individuals. A few studies report adverse effects on cognitive performance and/or educational achievement early in life and throughout adulthood. However, these studies are limited by small clinic-based samples, lack of appropriate control groups, and cross-sectional designs that ignore changes over time. Furthermore, none of these studies identifies socioeconomic, demographic or health factors that may interact with and modify the effects of NSCL-P on educational achievement. The proposed study will identify the impacts of NS CL-P on the educational achievement of children and adolescents with oral clefts and assess how these impacts vary by socioeconomic, demographic and health backgrounds. The study is highly innovative by employing a unique, existing data infrastructure to implement the study Specific Aims and by addressing several of the limitations of previous studies. We will study a large population-based sample of individuals with oral clefts from Iowa identified through the Iowa Registry for Congenital and Inherited Disorders (IRCID) and multiple control groups including siblings, classmates, and unaffected children from the National Birth Defects and Prevention Study (NBDPS). This multi-control group approach provides significant methodological advantages over previous studies. We measure educational achievement using the objective standardized Iowa school tests that were developed and are maintained at the University of Iowa and have high reliability and validity. We will evaluate scores on Reading, Mathematics, Language, and Science as well as overall composite scores. We will also link data from birth records and NBDPS survey data on health and socioeconomic and demographic characteristics and risk factors during pregnancy. Furthermore, we study the effects of NSCL-P on educational achievement and its changes with age using longitudinal designs. The study will add significant knowledge about the NSCL-P effects on educational achievement and about ways to improve the long-term outcomes of affected individuals.