The aim of this study was to determine the rate of and characterize academic deficits in pediatric-onset multiple sclerosis (POMS) and compare these to cognitive deficits. 

Unlike with adult-onset MS, where a great deal is known about the effects of cognitive dysfunction on daily life, the functional impact in POMS is largely understudied.  

We administered a battery of neuropsychological tests and the Woodcock Test of Achievement (WCJ) to 23 participants with POMS and 11 healthy children (HC). Academic underachievement was defined as: (1) a z score of ≤ -1.5 standard deviation (SD) on the WCJ based on age-based normative data, and/or (2) a failing score on ≥ 2 statewide exams. Cognitive impairment was defined as: a score ≤ -1.5 SD on a total ≥ 1/3 of all cognitive tests administered, compared to age-based norms.  

11 of 23 POMS (48%) demonstrated academic underachievement compared to 1 of 11 HC (9%) (p=0.03). 8 of 23 POMS (35%) met criteria for cognitive impairment, compared to zero HC (p=0.03). POMS scored lower than HC on the WCJ Total Achievement Scale (x¯=93.2 vs x¯=112.6; p=0.0024, CI= [7.38, 31.4]). POMS with academic deficits were not more likely to have cognitive impairment than POMS without academic deficits (p=0.06). POMS had significantly lower scores than HC on the timed fluency section of the WCJ (x¯=88.3 vs. x¯=105.9, p=0.00122, CI=[7.50, 27.7] and on a timed section of the IQ test versus untimed sections (p=0.005, CI=[-15.8, 3.04]). 40% of POMS scored ≥ 1SD above their age and gender norms on a self-report depression scale, while zero HC scored in that range.

Children with MS demonstrate high levels of academic underachievement. Dedicated academic achievement testing should be part of the structured cognitive evaluation for children with MS. Extended time on tests may represent a crucial academic accommodation for this group.