Dataset Information

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

ABSTRACT:

Background

Amblyopia is a neurodevelopmental condition causing reduced vision, for which programmes of whole population child vision screening exist throughout the world. There is an ongoing debate about the value of screening due to the lack of evidence about meaningful functional impacts of amblyopia. Our objective was to determine whether amblyopia is associated with school readiness and early cognitive performance.

Methods and findings

Data from the prospective Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 7 years (n = 13,967). Using parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into no eye conditions, strabismus alone, refractive amblyopia, or strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were poor school readiness using Bracken School Readiness Assessment <25th percentile (age 3); and cognitive tests and their age-related trajectories using British Ability Scale II Naming Vocabulary (ages 3/5) and Pattern Construction (ages 5/7). Multivariable analyses showed that compared to children without any eye conditions, only those with strabismic/mixed amblyopia had an increased risk of poor school readiness (OR = 2.04, 95%CI 1.09-3.82). Small differences in mean scores for NV and PC of children with amblyopia (all types) compared to those without any eye condition were not clinically significant (>10 points) irrespective of whether treatment had already started. The age-related cognitive trajectories of children with amblyopia did not differ from those without any eye conditions for either NV (p = 0.62) or PC (p = 0.51). These associations are at population rather than individual level, so it might be that some individuals with amblyopia did experience significant adverse outcomes that are not captured by summary statistics.

Conclusions

Amblyopia is not significantly associated with adverse cognitive performance and trajectories in early schooling and there is no evidence that this is due to a mediating effect of treatment. Although amblyopia combined with strabismus is associated with poor school readiness, this is not translated into poor cognitive performance. These novel findings may explain the lack of association reported between amblyopia and educational outcomes in adult life and suggest that the impact of amblyopia on education is not of itself a justification for whole population child vision screening aimed at detecting this disorder.

SUBMITTER: Gitsels LA

PROVIDER: S-EPMC7304573 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

Gitsels Lisanne Andra LA Cortina-Borja Mario M Rahi Jugnoo Sangeeta JS

PloS one 20200619 6

<h4>Background</h4>Amblyopia is a neurodevelopmental condition causing reduced vision, for which programmes of whole population child vision screening exist throughout the world. There is an ongoing debate about the value of screening due to the lack of evidence about meaningful functional impacts of amblyopia. Our objective was to determine whether amblyopia is associated with school readiness and early cognitive performance.<h4>Methods and findings</h4>Data from the prospective Millennium Coho ...[more]

PMID: 32559208

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Project description:BackgroundAmblyopia is a neurodevelopmental condition resulting in reduced vision for which whole population child vision screening is undertaken. Cross-sectional studies have established an association between amblyopia and lower academic self-concept, slower reading speed. No difference has been found in educational performance in adolescence whilst there are mixed associations with educational attainment in adults. Educational trajectories and intentions have not been studied previously. We analyse if those treated for amblyopia have different educational performance and trajectories for core subjects during statutory schooling, or subsequent higher education (university) intentions than their peers without eye conditions.Methods and findingsData from the Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 17 years (n = 9989). Using a validated approach drawing on parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into mutually exclusive categories: no eye conditions, strabismus alone, refractive amblyopia, strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were levels and trajectories of passing English, Maths, Science at ages 7-16 years, passing national exams at age 16, and intentions at ages 14-17 to pursue higher (university) education. Adjusted analyses showed that amblyopia status was not associated with performance in English, Maths, and Science at any key stage, attainment in national exams, or intending to go to university. Similarly, the age-related trajectories of performance in core subjects and higher education intentions did not differ between the groups. There were no significant differences in main reason for having or not having university intentions.ConclusionsWe found no associations between a history of amblyopia and either adverse performance or age-related attainment trajectories in core subjects during key stages of statutory schooling as well as the absence of an association with intentions for higher education. These results should be reassuring to affected children and young people, and their families, teachers and physicians.

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Project description:ObjectivesUniversity academic achievement may be inversely related to the performance of the secondary (high) school an entrant attended. Indeed, some medical schools already offer 'grade discounts' to applicants from less well-performing schools. However, evidence to guide such policies is lacking. In this study, we analyse a national dataset in order to understand the relationship between the two main predictors of medical school admission in the UK (prior educational attainment (PEA) and performance on the United Kingdom Clinical Aptitude Test (UKCAT)) and subsequent undergraduate knowledge and skills-related outcomes analysed separately.MethodsThe study was based on national selection data and linked medical school outcomes for knowledge and skills-based tests during the first five years of medical school. UKCAT scores and PEA grades were available for 2107 students enrolled at 18 medical schools. Models were developed to investigate the potential mediating role played by a student's previous secondary school's performance. Multilevel models were created to explore the influence of students' secondary schools on undergraduate achievement in medical school.ResultsThe ability of the UKCAT scores to predict undergraduate academic performance was significantly mediated by PEA in all five years of medical school. Undergraduate achievement was inversely related to secondary school-level performance. This effect waned over time and was less marked for skills, compared with undergraduate knowledge-based outcomes. Thus, the predictive value of secondary school grades was generally dependent on the secondary school in which they were obtained.ConclusionsThe UKCAT scores added some value, above and beyond secondary school achievement, in predicting undergraduate performance, especially in the later years of study. Importantly, the findings suggest that the academic entry criteria should be relaxed for candidates applying from the least well performing secondary schools. In the UK, this would translate into a decrease of approximately one to two A-level grades.

Project description:BackgroundEarly uptake of multiple risky behaviours during adolescence, such as substance use, antisocial and sexual behaviours, can lead to poor health outcomes without timely interventions. This study investigated how early-life maternal attachment, or emotional bonds between mothers and infants, influenced later risky behaviours in adolescence alongside other potential explanatory pathways using the United Kingdom Millennium Cohort Study.MethodsTotal maternal attachment scores measured at 9 months using the Condon (1998) Maternal Postnatal Attachment Scale compared higher and lower attachment, where mothers in the lowest 10th percentile represented lower attachment. Multiple risky behaviours, defined as two or more risky behaviours (including smoking cigarettes, vaping, alcohol consumption, illegal drug use, antisocial behaviour, criminal engagement, unsafe sex, and gambling), were scored from 0 to 8 at age 17. Five multivariate logistic regression models examined associations between maternal attachment and multiple risky behaviours among Millennium Cohort Study members (n = 7796). Mediation analysis sequentially adjusted for blocks of explanatory mechanisms, including low attachment mechanisms (multiple births, infant prematurity, sex, breastfeeding, unplanned pregnancy and maternal age at birth), maternal depression, and social inequalities (single-parent status, socioeconomic circumstance by maternal education and household income) at 9 months and poor adolescent mental health at 14 years.ResultsChildren of mothers with lower maternal attachment at 9 months had 23% increased odds of multiple risky behaviours at 17 years (OR: 1.23, 95% CI: 1.00-1.50) in the unadjusted baseline model. All five explanatory blocks attenuated baseline odds. Low attachment mechanisms attenuated 13%, social inequalities 17%, and poor mental health 17%. Maternal depression attenuated the highest proportion (26%) after fully adjusting for all factors (30%).ConclusionsLower maternal attachment in early life predicted increased adolescent multiple risky behaviours. Almost a third of the excess risk was attributable to child, maternal and socioeconomic factors, with over a quarter explained by maternal depression. Recognising the influence of early-life risk factors on adolescent health could innovate current policies and interventions addressing multiple risky behaviour uptake affecting health inequalities across the life course.

Dataset Information

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

Background

Methods and findings

Conclusions

Publications

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

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