Scottish Longitudinal Study
Development & Support Unit
An exploration of the links between preterm birth, socio-economic variables and educational outcomes
Maria Giatsi Clausen (Queen Margaret University, School Of Health Sciences)
Duncan Pentland (Queen Margaret University, School Of Health Sciences)
1st June 2016
Improvements in medical and technological interventions have led to increased survival rates for infants who would previously have likely died. The UK Office of National Statistics suggests that infants born as early as 24 and 25 weeks now have 39% and 50% survival rates respectively (Bliss, 2005). In the EPICure study, which is one of the largest population-based studies of infants of very low gestational age (GA), a national UK cohort of 4004 births was examined. Of the 811 extremely preterm children (<26 weeks GA) that were admitted for intensive care, 39% survived until they were discharged from hospital (Costeloe et al. 2000). Healthcare and educational systems now face new challenges in addressing the needs of children whose chances for survival were previously poor.
Literature suggests that children born preterm might present with ‘minor’ developmental problems that may however interfere with academic achievement. Swamy, Østbye and Skjærven’s (2008) population-based, longitudinal study included 1.1 million singleton births in Norway between 1967 and 1988. These births had occurred at 22 weeks or more of gestation, with birth weights of 500g or greater. One of the long-term outcomes investigated in the study was educational achievement. The study revealed a higher likelihood for preterm survivors to have low educational achievement, 95% CI, as determined by attendance of high school education and subsequent graduation. Poor educational attainment was observed both among male and female participants born preterm when compared to their full-term peers. The authors observed that the lower the gestational age of the participant, the greater the likelihood of not moving into high school education or having graduate education. In a study by Sjernqvist and Sverringsen (1999), the school achievement of 61 extremely preterm children (<29 weeks) was compared to that of 61 full-term peers (matched for gender and date of birth) at the age of 10 years. Ninety-two percent of the preterm children were found to attend mainstream schooling unlike their full-term peers, all of whom attended mainstream education. Thirty percent of the preterm group, and 1.6% of the full-term peers, were in need of some kind of special educational support, with this demonstrating a significant difference (p<0.001). Similar findings have been reported in other studies (Isaacs et al. 2001; Bowen, Gibson & Hand 2002; Marlow, Roberts & Cooke 1993).
In the light of legislation such as the Education (Additional Support for Learning) Scotland Act 2004, and policies likes Getting it Right for Every Child (Scottish Executive 2006), more emphasis should be given to the functional and educational outcomes associated with prematurity, with a view to informing educational arrangements for children with additional support needs. It is expected that the proposed study could serve this purpose.
The recently conducted study by MacKay at al (2012)1 also explored relationships between gestational age and birth weight centile, and specific causes of special educational need (SEN). It therefore shares commonalities with the proposed study. MacKay at al (2012) found that there is indeed an association between gestation and birth weight centile and overall risk of SEN, which is “largely driven by very strong associations with sensory, physical or motor impairments, and intellectual impairments” (p.297). The main differentiations between the two studies are listed below:
- 1. MacKay at al.’s study focused on special educational needs (SENs); the proposed study will be focusing rather on “additional support needs”. The Additional Support for Learning Act 2004 in Scotland introduced the concept of “additional support needs”, which is wider and more encompassing than the concept of “special educational needs”. The latter term only refers to children with particular types of learning needs, however, the new concept refers, for the first time, to “any child who, for whatever reason, requires additional support to learning” (Scottish Executive Education Department, 2004, p2). This definition could include preterm children who attend mainstream education, and who might receive additional educational support, albeit not necessarily related to SENs.
- Mac Kay at al.’s study focuses primarily on identifying type of difficulty (e.g. sensory and intellectual impairment) as opposed to the proposed study’s focus on school curriculum (area of difficulty e.g. handwriting)
- MacKay et al. include birth weight as a variable of interest in their study; in the proposed study, although birth weight will be requested as a variable, gestational age is the main defining criterion for prematurity, as current debate in literature proposes this to be considered the “right criterion” when exploring the effect of preterm birth on development; that is due to intra-uterine foetal growth restrictions often resulting to low-birth weight for children who might be born full-term1Mackay D.F., Smith G.C.S., Dobbie R., Cooper .S.A., & Pell J.P. (2013) Obstetric factors and different causes of special educational need: retrospective cohort study of 407 503 schoolchildren, BJOG; 120: 297–308.
The project plans to use data on SLS members who were born as singletons between the 1991 and 2001 censuses to link data from SMR02 records held at ISD to the 2001 Census and Education data at the SLS. The SMR02 data are required to obtain the gestational age at birth, and other birth variables, for the SLS members.
The present research protocol proposes the use of longitudinal data to determine links between variables which relate to demographic characteristics, birth and maternity data and socioeconomic variables, and school census data on school outcomes including performance and attainment.
- To explore links between maternity information especially gestational age and related outcomes from schooling, using data from the Maternity Inpatient and Day Case dataset (SMR02) records for live singleton births and school census, school attendance and, SQA attainment data. More specifically to address the following research hypotheses:
- Is there a relationship between SMR02 variables and school census data variables; e.g. is low gestational age related to more frequent specific learning difficulties? Or, is low gestational age related to certain types of additional support needs?
- Is there a relationship between Maternity Inpatient and Day Case variables (SMR02) and school attendance; e.g. Does low gestational age relate to incidence of absence from school when other confounding variables are considered? (as detailed under hypothesis 2 below).
- Is there a relationship between Maternity Inpatient and Day Case data (SMR02) and school exclusions
- Is there a relationship between Maternity Inpatient and Day Case data (SMR02) and SQA attainment
- Is there a relationship between SMR02 data and SQA qualifications
- To explore whether or not any relationships found (see above) might be confounded by other factors. These will be taken from the 2001 Census when the sample participants are aged between 0-10 years. These variables are health (specifically long term illness indicators; health status) and household level socio-economic variables (e.g. number of families in household, including one person family; employment status, education status etc), which may affect educational outcome of children.
Related Outputs (viewable on CALLS Hub):
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