Child mental health problems as a risk factor for academic underachievement: A multi-informant, population-based study

Isabel K. Schuurmans, Nathalie Tamayo Martinez, Elisabet Blok, Manon H.J. Hillegers, M. Arfan Ikram, Annemarie I. Luik, Charlotte A.M. Cecil*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: To investigate whether child mental health problems prospectively associate with IQ-achievement discrepancy (i.e., academic under- and over-achievement) in emerging adolescence. The secondary aims were to test whether these associations are specific to certain mental health problems, to assess potential sex differences, and to examine whether associations are robustly observed across multiple informants (i.e., maternal and teacher-reports). Methods: This study included 1,577 children from the population-based birth cohort the Generation R Study. Child mental health problems at age 6 were assessed by mothers and teachers using the Child Behavior Checklist and the Teacher's Report Form. The IQ-achievement discrepancy was quantified as the standardized residuals of academic achievement regressed on IQ, where IQ was measured with four tasks from the Wechsler Intelligence Scale for Children-Fifth Edition around age 13 and academic attainment was measured with the Cito test, a national Dutch academic test, at the end of elementary school (12 years of age). Results: Mental health problems at age 6 were associated with IQ-achievement discrepancy at age 12, with more problems associating with greater academic underachievement. When examining specific mental health problems, we found that attention problems was the only mental health problem to independently associate with the IQ-achievement discrepancy (adjusted standardized difference per 1-standard deviation, mother: −0.11, p < 0.001, 95% CI [−0.16, −0.06]; teacher: −0.13, p < 0.001, 95% CI [−0.18, −0.08]). These associations remained after adjusting for co-occurring mental health problems. The overall pattern of associations was consistent across boys and girls and across informants. Conclusion: Mental health problems during the transition from kindergarten to elementary school associate with academic underachievement at the end of elementary school. These associations were primarily driven by attention problems, as rated by both mothers and teachers—suggesting that strategies targeting attention problems may be a particularly promising avenue for improving educational performance irrespective of IQ, although this should be established more thoroughly through further research.

Original languageEnglish
Pages (from-to)578-590
Number of pages13
JournalActa Psychiatrica Scandinavica
Volume145
Issue number6
Early online date17 Mar 2022
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
We would like to thank all who have taken part in the Generation R study, being children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The ORACLE Study is funded by the European Research Council (ERC) under the European Union”s Horizon 2020 research and innovation programme (project: ORACLE, grant agreement No: 678543). The general design of Generation R Study has been funded by the Erasmus Medical Center, Rotterdam, ZonMw, the Netherlands Organization for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport, and is conducted by the Erasmus Medical Center in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. The work of NTM has received funding from EU”s New Opportunities for Research Funding Agency Co-operation in Europe (NORFACE) initiative (project: SEED, grant agreement No: 462-16-030). The work of CC has received funding from the European Union”s Horizon 2020 Research and Innovation Programme under grant agreement No 848158 (EarlyCause Project). The financial supporters did not influence the results of this work. As such, the funders had no role in the study design, data collection, analysis, interpretation of the data, or writing of the report.

Funding Information:
We would like to thank all who have taken part in the Generation R study, being children and parents, general practitioners, hospitals, midwives, and pharmacies in Rotterdam. The ORACLE Study is funded by the European Research Council (ERC) under the European Union”s Horizon 2020 research and innovation programme (project: ORACLE, grant agreement No: 678543). The general design of Generation R Study has been funded by the Erasmus Medical Center, Rotterdam, ZonMw, the Netherlands Organization for Scientific Research (NWO), and the Ministry of Health, Welfare and Sport, and is conducted by the Erasmus Medical Center in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR‐MDC), Rotterdam. The work of NTM has received funding from EU”s New Opportunities for Research Funding Agency Co‐operation in Europe (NORFACE) initiative (project: SEED, grant agreement No: 462‐16‐030). The work of CC has received funding from the European Union”s Horizon 2020 Research and Innovation Programme under grant agreement No 848158 (EarlyCause Project). The financial supporters did not influence the results of this work. As such, the funders had no role in the study design, data collection, analysis, interpretation of the data, or writing of the report.

Publisher Copyright:
© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

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