Children with inflammatory bowel disease may have difficulty functioning in school, particularly because their tendency to internalize problems can affect attendance, according to a study.

"Both IBD and its treatment have the potential to disrupt school functioning," said Wallace V. Crandall, MD, a study author and director of the Center for Pediatric and Adolescent Inflammatory Bowel Disease at Nationwide Children's Hospital.

Crandall noted that primary symptoms of IBD include abdominal pain, fatigue and diarrhea, while corticosteroid treatment may affect learning and memory. Patients may also have to spend hours in an infusion clinic to receive medicine intravenously.

Past research has suggested youth with IBD may have increased absences, but little is known about other areas of school functioning or related factors. "Children with other chronic illnesses have lower academic achievement than healthy children, but research on school functioning in [children with] IBD is limited," said Laura M. Mackner, PhD, the study's principal investigator and a staff member at the Center for Biobehavioral Health at The Research Institute at Nationwide Children's.

To provide data regarding school functioning in IBD, Mackner and Crandall examined absences, achievement, grade retention, special education and school-related quality of life in adolescents with IBD compared to healthy adolescents. They also investigated demographic, disease and psychosocial variables as predictors. Ninety-two adolescents ages 11 to 17 completed questionnaires assessing psychosocial and school functioning. Schools provided report cards and school absence information.

Findings showed that adolescents with IBD may experience more school difficulty than healthy children, mainly in regard to school absences. Demographic and psychosocial factors were significant predictors of absences and achievement, and the psychosocial factor of internalizing problems significantly predicted absences. "Youth with IBD are at increased risk for depression, so the finding that internalizing problems are associated with school absence is a particular concern with important implications," Mackner said.

In turn, school absence was significantly associated with GPA for youth with IBD. "Extended absences may result in lower GPAs and subsequently limit future educational and occupational opportunities," Mackner said.

Mackner highlighted the fact that school absence was associated with internalizing symptoms but not disease factors, saying the finding suggests interventions aimed at improving internalizing symptoms may result in improved attendance.

Crandall said most children in the study were in remission or had a mild symptoms, and it is unknown whether the same predictors would operate for children with more severe disease.

"Longitudinal research is needed to investigate whether school difficulty is associated with longer-term effects on future educational and occupational outcomes for these children," he said.

The study appears in the February/March issue of the Journal of Developmental & Behavioral Pediatrics. To read a summary and access the study via subscription or purchase, visit http://bit.ly/yX5GMI.