Educational attainment among primary school children with neurodisability: A population-based cohort study using linked education and health data from England.

ObjectiveTo support integrated health and education approaches by assessing differences in educational attainment between primary school children with and without a range of neurodisabilities. DesignPopulation-based cohort study. MethodsWe derived a national birth cohort of 2,351,589 children born in England between 01/09/2003-31/08/2008 enrolled in state-funded primary schools in Reception (age 4-5) using linked health and education records. Neurodisability was identified from hospital admission records. We described differences in primary school educational attainment for children with and without neurodisability. Results2.2% of children had a recorded neurodisability before starting Reception. These children consistently underperformed in national assessments, with fewer than half meeting nationally expected levels in Maths and English at every time point. By the end of primary school (age 10/11), 31% of children with neurodisability did not participate in national assessments despite being enrolled in school. Among children with neurodisability, educational attainment was lowest for children with Down syndrome and highest for children with perinatal conditions. ImplicationsSubstantial attainment gaps exist between children with and without neurodisability. By the end of primary school, many children with neurodisability are excluded from being formally assessed, highlighting the need for more personalised, functional outcome measures to ensure the meaningful evaluation of their educational development. KEY MESSAGESWhat is already known on this topic Children with neurodisability face functional challenges that can disrupt their success in school. There is limited understanding of their participation in national assessments and academic attainment throughout primary school on a population level in England. What this study adds: Large attainment gaps exist between children with neurodisability and their peers. Most (70% of) children with neurodisability who enter Year 1 are not school ready. A third of children with neurodisability are excluded from assessments at the end of primary school despite being enrolled in school. How this study might affect research, practice or policy: Health records can identify children with neurodisability early, supporting timely special educational needs and disability (SEND) assessments before school starts. Joint support provided by health and education systems may reduce the burden of neurodisability on school outcomes.