Determinants of Academic Achievement in Children with Psychiatric Disorders MICHAEL G. TRAMONTANA, PH.D., STEPHEN R. HOOPER, PH.D., ALISON D. CURLEY, PH.D., AND ELAINE M. NARDOLILLO, M.A. Abstract. Academic achievement within a child psychiatric sample was examined as a function of six variables: IQ, socioeconomic status, age, sex, neuropsychological status, and the severity of behavioral disturbance. As expected, the results revealed a different pattern of predictors than what is generally the case for normal schoolaged children. The results underscored the importance of neuropsychological factors, more than IQ and demographic variables, in understanding the academic deficits often seen in children with significant mental and emotional disturbance. J. Am. Acad. Child Adolesc. Psychiatrv, 1990,29,2:265-268. Key Words: academic achievement, child psychiatric patients, predictors, neuropsychological factors.
learning disabilities, substantial increases in the prediction of achievement have been obtained through the addition of a standardized battery of neuropsychological tests (Hale and Foltz, 1982; Strom et a!., 1987). Given the relatively high prevalence of learning disabilities among children with psychiatric disorders, neuropsychological assessment should result likewise in an improved prediction of their academic achievement. More generally, the precise pattern of predictors may differ from what generally has been found for normal school-aged children. This issue was addressed in the present study in which the determinants of academic achievement were examined specifically for children and adolescents with psychiatric disorders. The relative influence of six variables was assessed: IQ, socioeconomic status, age, sex, neuropsychological status, and the severity of behavioral disturbance. It was predicted that whereas the effects of demographic factors would be attenuated in this type of population, neuropsychological and behavioral factors would contribute significantly to the prediction of academic achievement for children with psychiatric disorders.
Correlates of academic achievement within the general population of school-aged children have been studied extensively. Overall, factors such as IQ and socioeconomic status appear to be among the most important determinants of general academic performance and educational outcomes (Spreen, 1988; Tramontana, et aI., 1988b). Deficits in specific abilities also have been found to playa critical role, with the precise effects on achievement varying according to age and the particular area of academic performance assessed (Fletcher and Satz, 1980; Rourke, 1985). The determinants of achievement are less clear in the case of children with significant emotional or behavioral disturbance. Behavioral factors are likely to playa particularly important role for these children, more so than what generally has been the relatively small increase in prediction that is obtained with the addition of behavioral measures to intelligence measures alone (Kohn and Rosman, 1974; McDermott, 1984). Moreover, children with psychiatric disorders have been found to show a relatively high rate of learning disabilities, speech and language disorders, and other neuropsychological deficits that can impede their academic learning and school progress (Tramontana et aI., 1980; Gualtieri et a!., 1983). Some investigators have suggested that learning disabilities and other indications of abnormal brain function in children constitute important risk factors in the development of psychiatric disturbance. (Rutter et a!., 1976; Shaffer et a!., 1985). It is well known that learning disabilities are not predicted very well on the basis of IQ alone. Among children with
Method
Subjects The participants in this study consisted of 50 hospitalized child and adolescent psychiatric patients who were referred for neuropsychological assessment. In all cases, the referral was initiated by the attending psychiatrist because of suspected learning impediments and other neuropsychological deficits. Soft neurological signs were quite common, but only about 10% of the sample had a documented neurological history (consisting mainly of seizures or head injury). Sixteen percent of the group was left-handed (based on hand preference for name-writing). The hospital setting was a private, acute-care, child psychiatric treatment center serving southern New England. On average, cases referred for neuropsychological assessment represented about 24% of total hospital admissions. The setting also included an intermediate-care day hospital program from which 26% of the subject sample was drawn. The subject group was mixed with respect to psychiatric diagnosis and the type of treatment being received. Discharge diagnoses were clustered as follows: disruptive behavior disorders (N = 12), mood disorders (N = 18), a
Accepted September 21. 1989. Dr. Tramontana is an Associate Professor in the Department of Psychiatry at Vanderbilt University. He was formerly at Brown University. and. along with Ms. Nardolillo, was based in the Neuropsychology Lab at Bradley Hospital in East Providence. Rhode Island when this study was conducted. Dr. Hooper is an Assistant Professor in the Department of Psychiatry and the Clinical Center for the Study of Development and Learning. University of North Carolina School of Medicine. Dr. Curley is in the Department of Psychology at Sunnyview Hospital. Schenectady. New York. She was a Postdoctoral Fellow in Child Neuropsychology at Bradley Hospital when this study was conducted. Reprint requests to: Dr. Tramontana, Vanderbilt Child and Adolescent Psychiatric Hospital. 1601 23rd Avenue South. Nashville. TN 37212.
0890-8567/90/2902-0265$02.0010© 1990 by the American Academy of Child and Adolescent Psychiatry.
265
TRAMONTANA ET A L.
mixed group con sistin g of disruptive behavior and mood disorders (N = 9) , psych otic di sorders (N = 5), and other disorders (N = 6). Lastly , abo ut one-third of the group was being treated with psychotropi c medi cation at the time o f testing (N = 18), with half of these cases specifica lly receiving an antidepressant. Procedures
All subjects were evaluated within 10 days of hospit al admi ssion on the Woodcock-Johnson Tests of Achievem ent (Woodcoc k and Johnson, 1977 ). The use of a standardized measure such as the Woodcock-Johnson prov ided a more objective and consistent frame of reference for evalua ting academic achievement than would have been possible with other indices such as grade-point average or teacher rat ing s of academic skills. Moreover, the Woodcock-Johnson has been found to have excellent reliability and validity when compared with other standardiz ed measures of achievement (Kaufman, 1985). It provided a comprehensive asse ssm ent of academic achievement, with major areas including reading , mathematics, written language , knowledge, and skills . Age-normed standard scores for the group were exami ned specifically in reading
learning disabilities, substantial increases in the prediction of achievement have been obtained through the addition of a standardized battery of neuropsychological tests (Hale and Foltz, 1982; Strom et a!., 1987). Given the relatively high prevalence of learning disabilities among children with psychiatric disorders, neuropsychological assessment should result likewise in an improved prediction of their academic achievement. More generally, the precise pattern of predictors may differ from what generally has been found for normal school-aged children. This issue was addressed in the present study in which the determinants of academic achievement were examined specifically for children and adolescents with psychiatric disorders. The relative influence of six variables was assessed: IQ, socioeconomic status, age, sex, neuropsychological status, and the severity of behavioral disturbance. It was predicted that whereas the effects of demographic factors would be attenuated in this type of population, neuropsychological and behavioral factors would contribute significantly to the prediction of academic achievement for children with psychiatric disorders.
Correlates of academic achievement within the general population of school-aged children have been studied extensively. Overall, factors such as IQ and socioeconomic status appear to be among the most important determinants of general academic performance and educational outcomes (Spreen, 1988; Tramontana, et aI., 1988b). Deficits in specific abilities also have been found to playa critical role, with the precise effects on achievement varying according to age and the particular area of academic performance assessed (Fletcher and Satz, 1980; Rourke, 1985). The determinants of achievement are less clear in the case of children with significant emotional or behavioral disturbance. Behavioral factors are likely to playa particularly important role for these children, more so than what generally has been the relatively small increase in prediction that is obtained with the addition of behavioral measures to intelligence measures alone (Kohn and Rosman, 1974; McDermott, 1984). Moreover, children with psychiatric disorders have been found to show a relatively high rate of learning disabilities, speech and language disorders, and other neuropsychological deficits that can impede their academic learning and school progress (Tramontana et aI., 1980; Gualtieri et a!., 1983). Some investigators have suggested that learning disabilities and other indications of abnormal brain function in children constitute important risk factors in the development of psychiatric disturbance. (Rutter et a!., 1976; Shaffer et a!., 1985). It is well known that learning disabilities are not predicted very well on the basis of IQ alone. Among children with
Method
Subjects The participants in this study consisted of 50 hospitalized child and adolescent psychiatric patients who were referred for neuropsychological assessment. In all cases, the referral was initiated by the attending psychiatrist because of suspected learning impediments and other neuropsychological deficits. Soft neurological signs were quite common, but only about 10% of the sample had a documented neurological history (consisting mainly of seizures or head injury). Sixteen percent of the group was left-handed (based on hand preference for name-writing). The hospital setting was a private, acute-care, child psychiatric treatment center serving southern New England. On average, cases referred for neuropsychological assessment represented about 24% of total hospital admissions. The setting also included an intermediate-care day hospital program from which 26% of the subject sample was drawn. The subject group was mixed with respect to psychiatric diagnosis and the type of treatment being received. Discharge diagnoses were clustered as follows: disruptive behavior disorders (N = 12), mood disorders (N = 18), a
Accepted September 21. 1989. Dr. Tramontana is an Associate Professor in the Department of Psychiatry at Vanderbilt University. He was formerly at Brown University. and. along with Ms. Nardolillo, was based in the Neuropsychology Lab at Bradley Hospital in East Providence. Rhode Island when this study was conducted. Dr. Hooper is an Assistant Professor in the Department of Psychiatry and the Clinical Center for the Study of Development and Learning. University of North Carolina School of Medicine. Dr. Curley is in the Department of Psychology at Sunnyview Hospital. Schenectady. New York. She was a Postdoctoral Fellow in Child Neuropsychology at Bradley Hospital when this study was conducted. Reprint requests to: Dr. Tramontana, Vanderbilt Child and Adolescent Psychiatric Hospital. 1601 23rd Avenue South. Nashville. TN 37212.
0890-8567/90/2902-0265$02.0010© 1990 by the American Academy of Child and Adolescent Psychiatry.
265
TRAMONTANA ET A L.
mixed group con sistin g of disruptive behavior and mood disorders (N = 9) , psych otic di sorders (N = 5), and other disorders (N = 6). Lastly , abo ut one-third of the group was being treated with psychotropi c medi cation at the time o f testing (N = 18), with half of these cases specifica lly receiving an antidepressant. Procedures
All subjects were evaluated within 10 days of hospit al admi ssion on the Woodcock-Johnson Tests of Achievem ent (Woodcoc k and Johnson, 1977 ). The use of a standardized measure such as the Woodcock-Johnson prov ided a more objective and consistent frame of reference for evalua ting academic achievement than would have been possible with other indices such as grade-point average or teacher rat ing s of academic skills. Moreover, the Woodcock-Johnson has been found to have excellent reliability and validity when compared with other standardiz ed measures of achievement (Kaufman, 1985). It provided a comprehensive asse ssm ent of academic achievement, with major areas including reading , mathematics, written language , knowledge, and skills . Age-normed standard scores for the group were exami ned specifically in reading
