WHAT'S KNOWN ON THIS SUBJECT: Previous studies that reported learning deficits among children with oral clefts mostly used small, clinic-based samples prone to ascertainment bias. No previous studies in the United States have used a populationbased sample and direct testing of academic achievement. WHAT THIS STUDY ADDS:Using a large population-based sample from the United States and standardized school tests for achievement, we found that children with oral clefts scored significantly lower than their classmates on all evaluated domains of achievement and had higher rates of learning disability. abstract BACKGROUND AND OBJECTIVE: Previous studies of academic achievement of children with oral clefts have mostly relied on small, clinicbased samples prone to ascertainment bias. In the first study in the United States to use a population-based sample with direct assessment, we evaluated the academic achievement of children with oral clefts relative to their classmates. METHODS:Children born with isolated oral clefts in Iowa from 1983 to 2003 were identified from the Iowa Registry for Congenital and Inherited Disorders and matched to unaffected classmates by gender, school/school district, and month and year of birth. Academic achievement was assessed by using standardized tests of academic progress developed by the Iowa Testing Programs. Iowa Testing Programs data were linked to birth certificates for all children. Regression models controlled for household demographic and socioeconomic factors. The analytical sample included 588 children with clefts contributing 3735 child-grade observations and 1874 classmates contributing 13 159 child-grade observations. RESULTS: Children with oral clefts had lower scores than their classmates across all domains and school levels, with a 5-percentile difference in the overall composite score. Children with clefts were approximately one-half grade level behind their classmates and had higher rates of academic underachievement and use of special education services by 8 percentage points. Group differences were slightly lower but remained large and significant after adjusting for many background characteristics.CONCLUSIONS: Children with oral clefts underperformed across all academic areas and grade levels compared with their classmates. The results support a model of early testing and intervention among affected children to identify and reduce academic deficits. Pediatrics 2014;133:785-792
The purpose of this investigation was to study the nature of the item and ability estimates obtained when the modified three-parameter logistic model is used with two-dimensional data. To examine the effects of two-dimensional data on unidimensional parameter estimates, the relative potency of the two dimensions was systematically varied by changing the correlations between the two ability dimensions. Data sets based on correlations of .0, .3, .6, .9, and .95 were generated for each of four combinations of sample size and test length. Also, for each of these four combinations, five unidimensional data sets were simulated for comparison purposes. Relative to the nature of the unidimensional estimates, it was found that the â value seemed best considered as the average of the true a values. The b value seemed best thought of as an overestimate of the true b 1 values. The & t h e t a s ; value seemed best considered as the average of the true ability parameters. Although there was a consistent trend for these relationships to strengthen as the ability dimensions became more highly correlated, there was always a substantial disparity between the magnitudes of these values and of those derived from the unidimensional data. Sample size and test length had very little effect on these relationships.Research related to item response theory (IRT) has dominated the psychometric literature in recent years. This is not surprising since this theory has the potential to resolve many problems frequently encountered in psychological and educational measurement (Lord, 1980). However, the mathematical models on which this theory is founded are based on some very strong assumptions. In particular, IRT models most commonly used assume that the response data are unidimensional in the reference population.The importance of the unidimensionality assumption has been stressed by many authors (see e.g., H~rrlbiet®r~ ~ Murray, 1983;Traub, 1983). Several researchers have hypothesized that failure to satisfy the assumption of unidimensionality was a major reason IRT models did not adequately fit their data. For example, Loyd and Hoover (1980) reported that multidimensional data might have contributed to the lack of fit of the Rasch model in a vertical equating setting. In comparing the fit of the one-and three-parameter logistic models to actual standardized test data, Hutten (1980) found that the potency of the major dimension (as assessed by the ratio of the first two eigenvalues of the matrix of inter-item tetrachoric correlations) was significantly related to the degree of fit.
The current study assessed psychotherapy clients' beliefs about the appropriateness of discussing religious and spiritual concerns in counseling, clients' preferences for such discussion, and identified explanatory variables for these beliefs and preferences. These variables were assessed using the Client Attitudes toward Spirituality in Therapy survey; the Index of Spiritual Experiences (
Objectives To examine trajectories in academic achievement for children with oral clefts versus unaffected classmates and explore predictors of persistently low achievement among children with oral clefts. Design Longitudinal cohort study of academic achievement in a population-based sample. Setting and Participants Children born from 1983 through 2003 with oral clefts were identified from the Iowa Registry for Congenital and Inherited Disorders and matched to unaffected classmates by sex, school/school district, and month and year of birth. Main Outcome Measures Academic achievement was measured from Iowa Testing Programs (ITP) data. Outcomes included achievement scores in reading, language, and mathematics. Results Academic achievement data were available for 586 children with oral clefts and 1,873 unaffected classmates. Achievement trajectories were stable for both groups. Children with oral clefts were more likely than their classmates to be classified into persistent, low achievement trajectories, including when adjusting for socioeconomic differences: OR=1.63, 95% CI: 1.23–2.16 for reading; OR=1.73, 95% CI: 1.29–2.31 for language; OR=1.45, 95% CI: 1.05–1.99 for math. Predictors of low achievement were cleft palate only (versus other cleft types), adolescent mothers, low maternal education, and less frequent use of prenatal care. Conclusions Most children have steady academic trajectories and children with oral clefts are at greater risk for persistent, low achievement in school than unaffected classmates. These findings support the need for routine, early screening for academic deficits in this population. Cleft palate only, low parental education and adolescent mothers are associated with increased risk for persistent low achievement.
Children with OFC and their siblings received similar achievement scores. Younger siblings, in particular, may share a vulnerability to poor academic outcomes.
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