Today’s piece was prepared by Eric Johnson, MD and is based on an article from MSNBC.com entitled “Young kids with asthma may lag in reading skills.”

Summary:

The author journalist reports the results of a New Zealandstudy conducted by Dr. Kathleen Liberty of the University of Canterbury in Christchurch, New Zealand. The study, published in the journal CHEST, sought to discover if there are measurable differences in comparing school performancematch and reading achievement between 298 young children with (18%)and without asthma, compared to those without asthma. The researchers measured both math and reading achievement in 298 New Zealand children, and also recorded whether or not each child had asthma. If they did have asthma (18% of the study participants), they recorded how severe their disease was, although they did not prospectively follow changes in disease severity during the study. They controllinged for socioeconomic status, school “readiness”, and absenteeism. Initial disease severity was documented but not prospectively followed during the study. After completing the first year of school, they researchers re-evaluated math and reading achievement, and found that “discovering 51%percent of . . . children w[with asthma ] vs. 33% without asthma were at least six months behind in reading words, and 55% vs. 38%percent lagged in reading sentences. That compared with 33 percent and 38 percent of children without asthma.” Based on these findings, theTheauthor journalist concludes: “Young children who start school with asthma may lag behind their peers in developing reading skills.”

Critique:

This article discusses a link between two relatively common diagnoses circumstances in school-age children: asthma and learning disabilitiessuboptimal academic achievement. Both of these “disorders”phenomena are often multifactorial in etiology, making it difficult to determine a causal relationship between the two. Although the author journalist reports that the findings “do not prove that asthma per se is the reason for the gap” between children with and without asthma, parents who read this article may misinterpret the information in several ways. For example: asthma directly causes learning disabilitiesacademic underachievement (not proven or plausible at this time), or treating asthma may improve school academic performance (not proven, but is possible through factors such as improving attendance).

Other researchers have tried to investigate a link between asthma and learning disabilitiesacademic performance. Silverstein et al conducted a retrospective study comparing children with and without asthma, finding that although children with asthma had increased rates of absenteeism, “the school performance of children with asthma was similar to that of children without asthma.” Stingone et al conducted a cross-sectional study, concluding: “Inadequate asthma control may contribute to a greater risk of asthmatic children residing in urban areas being placed in special education.” However, the data in this study was were based on responses in a parent questionnaire. Based on a preliminary search, there are no other prospective studies regarding the association between asthma and learning disabilities.[s1]

Given this information, itParents of asthmatic children who read this article may seems prudent to recommend that parents treat their child’s asthma and learning disability as separate disorders, both of which may require specific and targeted interventions. It would be a shame to miss adiagnosis ofdraw premature conclusions about academic risks or poor performance, without further investigation into sources such as hearing impairment, dyslexia, or ADHD because a parent assumed that their child’s impaired reading performance was primarily due to their asthma. As health care providers, while we know that primary and secondary consequences of having successfully controlling a chronic diseases can influence academic performance, all children suspected of academic underachievement deserve, and are required by law to receive, a “free and appropriate public education” (FAPE), determined in part by investigations that use common and standardized measures. such as asthma can have many secondary benefits for our patients, the current data supports independent evaluation and treatment for learning disorders in children.

References:

Liberty, K. et al. “Beginning school with asthma independently predicts low achievement in a prospective cohort of children. Chest. 138(6):1349-55, December 2010.

Silverstein, M. et al. “School attendance and school performance: A population-based study of children with asthma.” Journal of Pediatrics. 139(2):278-283, August 2001.

Stingone , J. et al. “Asthma and Enrollment in Special Education Among Urban Schoolchildren.” American Journal of Public Health. SCHOOL HEALTH POLICY. 96(9):1593-1598, September 2006.

Resources:

The following may be helpful to health care providers and families in understanding this topic:

  • WA State Chapter of the national association that supports children with learning disabilities, as well as their parents and educators[s2]
  • PBS website that explores the experience of trying to learn with a learning disability
  • Nonprofit that focuses on general information and advocacy for children with disabilities

Eric: Some other suggestions for resources, if you agree:

(School Readiness)

(Students with Chronic Illnesses: Guidance for Families, Schools and Students – from the NIH)

And that’s today’s Developmental & Behavioral Pediatrics: IN THE NEWS!

[s1]Eric, was this your search? If so, did you specifically use the search term ‘learning disability’? If so, we may want to omit this statement, since the article is not about learning disabilities. Alternatively, you could rephrase the sentence so that it's clear to the reader that an alternative consideration is learning disability, AND that when looking for prospective studies linking asthma to LD, nothing is noted, or some such statement like that.

[s2]A great resource, but probably not relevant to this article.