Study shows children with IBD have difficulty in school, mostly due to absences

Children with inflammatory bowel disease (IBD) may have difficulty functioning in school, particularly because their tendency to internalize problems can impact attendance. These are the findings from a Nationwide Children's Hospital study appearing in the Journal of Developmental & Behavioral Pediatrics.

"Both IBD and its treatment have the potential to disrupt school functioning," said Wallace V. Crandall, MD, director of the Center for Pediatric and Adolescent Inflammatory Bowel Disease at Nationwide Children's and study author. "Primary symptoms of IBD include abdominal pain, fatigue and diarrhea. Corticosteroids affect learning and memory and intravenous medication requiring hours in an infusion clinic."

Some research suggests that youth with IBD may have increased absences, but little is known about other areas of school functioning or related factors. "Children with other chronic illnesses have lower academic achievement than healthy children, but research on school functioning in IBD is limited," Laura M. Mackner, PhD, investigator in the Center for Biobehavioral Health at The Research Institute at Nationwide Children's and principal investigator of the study.

To provide data regarding school functioning in IBD, Drs. Mackner and Crandall examined absences, achievement, grade retention, special education and school-related quality of life in adolescents with IBD compared to healthy adolescents. They also investigated demographic, disease and psychosocial variables as predictors. Ninety-two adolescents 11 to 17 years old completed questionnaires assessing psychosocial and school functioning (the Child Behavior Checklist and the Pediatric Quality of Life Inventory). Schools provided report cards and school absence information.

Findings showed that adolescents with IBD may experience more school difficulty than healthy children, mainly in regard to school absences. Demographic and psychosocial factors were significant predictors of absences and achievement and the psychosocial factor of internalizing problems significantly predicted absences. "Youth with IBD are at increased risk for depression, so the finding that internalizing problems are associated with school absence is a particular concern with important implications," said Dr. Mackner.

In turn, school absence was significantly associated with GPA for youth with IBD. "Extended absences may result in lower GPAs and subsequently limit future educational and occupational opportunities," said Dr. Mackner. Dr. Mackner says the fact that school absence was associated with internalizing symptoms but not disease factors suggests that interventions aimed at improving internalizing symptoms may result in improved attendance.

Dr. Crandall notes that most children in the study were in remission or had mild disease and it is unknown whether the same predictors would operate for children with more severe disease.

"Longitudinal research is needed to investigate whether school difficulty is associated with longer term effects on future educational and occupational outcomes for these children," he said.