Academic Achievement of Children and Adolescents with Neurofibromatosis Type 1: A Systematic Review and Meta-Analysis

This meta-analysis estimated academic achievement differences between children and adolescents with and without Neurofibromatosis type 1 (NF1) and explored potential moderators. Systematic literature searches from inception to March 2025 identified 2,531 unique articles, with 39 studies (146 effect sizes) met inclusion criteria. These studies encompassed data from 3,681 individuals with NF1 (43.95% female; M_age = 10.50 years, SD = 2.53) and 15,153 without NF1 (48.92% female; M_age = 9.85 years, SD = 3.03). Group differences in academic achievement (Hedges' g) were synthesized using robust standard error estimation and random effect models. Individuals with NF1 exhibited lower achievement in reading (g = -0.79, 95% CI [-0.95, -0.64]), writing (g = -0.82, 95% CI [-0.95, -0.68]), and math (g = -0.77, 95% CI [-0.90, -0.65]). Group disparities were present across reading subskills with greater differences in pseudoword reading (g = -1.43, 95% CI [-1.98, -0.89]) and word reading (g = -0.96, 95% CI [-1.26, -0.67]) than reading fluency (g = -0.62, 95% CI [-1.00, -0.23]). Lower full-scale IQ and verbal IQ were linked to greater group disparities in writing, but not in reading or math. Disparities were greater when unaffected siblings were used as controls (vs. normative data) in reading and writing. These findings underscore the need for targeted support and educational interventions for individuals with NF1.