TOPLINE:

Children with neurodisability were at increased risk for not meeting expected standards in mathematics and English throughout primary school, with nearly 1 in 3 being unable to participate in national assessments by the age of 10-11 years compared with those without neurodisability.

METHODOLOGY:

• Researchers used linked health and education records to examine educational attainment throughout primary school at ages of 5, 7, and 11 years in children with vs without neurodisability.
• A total of 2,351,589 singleton children born in England between September 1, 2003, and August 31, 2008, who were enrolled in state-funded primary schools at reception (age of 4-5 years) were included and followed up until the age of 10-11 years or death, whichever occurred first.
• Neurodisability was identified using diagnostic and procedure codes recorded in hospital admissions or listed as a cause of death between birth and the start of reception.
• Educational attainment was assessed at three timepoints: at ages of 4-5, 6-7, and 10-11 years; assessment participation, achievement of nationally expected levels, and standardised test scores were also evaluated.

TAKEAWAY:

• Overall, 2.2% of children were identified with neurodisability on the basis of hospital records before school entry.
• Children with neurodisability were consistently at a higher risk for not meeting expected levels, with more than double the risk in mathematics (adjusted risk ratio [aRR], 2.08-2.29) and a 74%-94% higher risk in English (aRR, 1.74-1.94) across all timepoints than that among those without neurodisability.
• Non-participation in assessments increased substantially over time among those with neurodisability, rising from 1.5% at reception to 3.4% in English and 4.0% in mathematics at the age of 6-7 years and reaching 31% for both subjects by the age of 10-11 years compared with 6.4% among unaffected peers.
• Among children with neurodisability, educational attainment in mathematics varied considerably, with those with perinatal conditions achieving the highest expected levels throughout primary school and those with Down syndrome achieving the lowest.

IN PRACTICE:

"The persistence of large attainment gaps suggests current provision is insufficient and highlights the opportunity to use clinical data to identify educational needs earlier and ensure appropriate support from school entry," the authors wrote.

SOURCE:

This study was led by Ayana Cant, UCL Great Ormond Street Institute of Child Health, London, England. It was published online on March 22, 2026, in Archives of Disease in Childhood.

LIMITATIONS:

The study relied on hospital admission records to identify neurodisability, which may have missed milder or undiagnosed cases and led to misclassification. Children with milder or later diagnosed neurodisability may have been included in the comparison group, potentially underestimating both prevalence and attainment gaps. Additionally, children from multiple or twin births were excluded to ensure accurate data linkage.

DISCLOSURES:

This study was supported by the National Institute for Health and Care Research under its Programme Grants for Applied Research Programme and Health Data Research UK, which is funded by the Medical Research Council and eight other funders. The authors did not declare any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.