Children With MS Do Well at School Despite Challenges, Danish Study Finds

Children with multiple sclerosis (MS) perform as well at school as healthy peers, but are more challenged in their mental health and make greater use of healthcare services, according to a recent study.

Psychiatric problems in these young patients are also more frequent than in children with chronic disorders that don’t affect the brain, its researchers reported.

The study, “School performance, psychiatric comorbidity, and healthcare utilization in pediatric multiple sclerosis: A nationwide population-based observational study,” was published in the Multiple Sclerosis Journal.

MS is associated with some comorbidities, or disorders occurring simultaneously in the same person. With pediatric MS, these include problems of attention, processing speed, visual-motor skills, and language. Psychiatric disorders such as depression and anxiety, as well as excessive fatigue are also common.

Researchers in Denmark sought to understand how these factors might affect school performance and hospitalizations compared to both healthy children from the general population, and those with non-brain-related chronic disorders such as diabetes.

Using Denmark’s nationwide health records, they identified 92 cases of pediatric MS (under 18 years old) between Jan. 1, 2008 and Dec. 31, 2015. The median age at MS onset was 16.1 years.

The team compared medical outcomes to two control groups: 920 healthy children — matched to MS children by sex and birthdate — and 9,108 children with inflammatory bowel disease, rheumatoid arthritis, or type 1 diabetes.

For academic performance, they analyzed records of 811,464 healthy children and 4,545 children with non-brain-related chronic disease.

Results showed that grades in Danish and mathematics did not differ significantly between groups, indicating that children with MS performed at similar levels.

“No difference in secondary and high school marks between children with MS, healthy children, and children with non-brain-related chronic disease” were seen, the researchers wrote.

Children with MS, however, experienced significantly more psychiatric comorbidities than did healthy children (a 3.43-times higher likelihood), and more than children with those other chronic diseases (a 1.87-times higher likelihood).

This higher rate of psychiatric problems seen in MS children compared to those with non-brain-related disorders represents a new finding, the team noted.

MS children also used more psychiatric medications, and made more out-of-hospital mental health visits than the other groups.

Healthcare usage was measured through primary care visits, such as seeing a general practitioner or specialist; all hospital visits, meaning both inpatient and outpatient; and hospital admissions — inpatient visits only — over a five-year period beginning at symptom onset.

Children with MS used healthcare services across all metrics more frequently than did healthy children. They had, for instance, four times the rate of hospital admissions at one year follow-up. The relative difference between these groups declined, however, over the five-year period.

Compared to children with other chronic disorders, those with MS visited the hospital more frequently but had a significantly lower rate of hospital admissions. Almost no difference was seen between these two groups in terms of primary care visits.

“Children with MS compared with children with non-brain-related chronic diseases had an almost doubled hazard for psychiatric comorbidity and a higher rate of all hospital visits, but a lower rate of hospital admissions,” the researchers wrote.

Overall, they concluded that “children with MS have a seemingly standard school performance but increased psychiatric comorbidity and a high rate of healthcare utilization.”

However, “there may be variability in the cognitive functioning in children with MS since a lower proportion of these children attended high school,” they added.