Academic achievement in children with orofacial clefts: A nationwide study in Sweden

To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children and whether this association is modified by sex and psychiatric comorbidity.

A register-based cohort of children born with cleft lip (CL), cleft lip and palate (CLP), and cleft palate only (CPO) in Sweden between 1973 and 2004 (n = 6286) was compared to a matched community cohort (n = 61,352). Outcomes were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9, and upper secondary school; all subjects' grades in school year 9; and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used.

For the majority of outcomes, no statistically significant group differences were observed, and generally children with CL were less affected than those with CLP and CPO. Children with CPO demonstrated lower achievement in the third school year (Swedish; aOR 0.54, 95% CI 0.40-0.72, mathematics; aOR 0.54, 95% CI 0.42-0.70), in Swedish in the ninth school year (aOR 0.89, 95% CI 0.80-0.99), and in mathematics in upper secondary school (aOR 0.87, 95% CI 0.76-1.00). Individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.67-0.98). Children with CLP demonstrated lower achievement in mathematics in the third school year (aOR 0.72, 95% CI 0.54-0.95) and in both Swedish and mathematics in the ninth school year (Swedish; aOR 0.89, 95% CI 0.80-0.99, mathematics; aOR 0.87, 95% CI 0.78-0.97). The majority of outcomes were less favorable in females but not for those with psychiatric comorbidity.

Our findings emphasize the need to screen children with clefts for learning difficulties to provide additional support in school. Girls with OFC appeared to be particularly vulnerable in this regard.