Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database

Keywords administrative data; cerebral palsy; children; primary school; special education; ECHILD database; inequalities ALL Metrics - Views Downloads How to cite this article Lewis KM, Nguyen VG, Zylbersztejn A et al. Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:39 (https://doi.org/10.3310/nihropenres.13618.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Study Protocol [version 1; peer review: 1 approved] Kate M Lewis https://orcid.org/0000-0003-1148-1017 1, Vincent G Nguyen https://orcid.org/0000-0002-9776-6242 1, Ania Zylbersztejn https://orcid.org/0000-0003-1035-1448 1, Sorcha Ni Chobhthaigh https://orcid.org/0000-0002-5215-6352 2, Lorraine Dearden3, Bianca De Stavola https://orcid.org/0000-0001-7853-0528 1Kate M Lewis https://orcid.org/0000-0003-1148-1017 1, Vincent G Nguyen https://orcid.org/0000-0002-9776-6242 1, [...] Ania Zylbersztejn https://orcid.org/0000-0003-1035-1448 1, Sorcha Ni Chobhthaigh https://orcid.org/0000-0002-5215-6352 2, Lorraine Dearden3, Bianca De Stavola https://orcid.org/0000-0001-7853-0528 1 PUBLISHED 09 Jul 2024 Author details Author details 1 Great Ormond Street Institute of Child Health, University College London, London, England, WC1N 1EH, UK 2 Institute for Global Health, University College London, London, England, WC1N 1DP, UK 3 Social Research Unit, University College London, London, England, WC1H 0AL, UK 2 Institute for Global Health, University College London, London, England, WC1N 1DP, UK 3 Social Research Unit, University College London, London, England, WC1H 0AL, UK Kate M Lewis Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Vincent G Nguyen Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Ania Zylbersztejn Roles: Data Curation, Writing – Review & Editing Roles: Data Curation, Writing – Review & Editing Sorcha Ni Chobhthaigh Roles: Writing – Review & Editing Roles: Writing – Review & Editing Lorraine Dearden Roles: Funding Acquisition, Writing – Review & Editing Roles: Funding Acquisition, Writing – Review & Editing Bianca De Stavola Roles: Funding Acquisition, Writing – Review & Editing Roles: Funding Acquisition, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Special educational needs (SEN) legislation emphasises justifiable and fair service provision, but a lack of information on the underlying support requirements of pupils has hampered efforts to quantify the extent of inequity between need and provision. Using linked health-education data, the aim of this study is to compare time to first recorded SEN provision in school records for children with hospital-record defined cerebral palsy, by sociodemographic factors. We will use linked pseudonymised individual-level state-funded hospital and school records from the Education and Health Insights from Linked Data (ECHILD) database. Our population will be children with cerebral palsy born in England between 1 September 2003 and 31 August 2012, who attended a state-funded primary school in England. We will create staggered cohorts based on different school entry points, from nursery to year 1 (ages 3/4 to 5/6 years). Cerebral palsy will be identified using diagnoses in hospital records before school entry. Our main outcome is time to SEN provision, defined by a recording of an education, health and care plan or SEN support at January censuses from school entry to the end of primary school (year 6, age 10/11 years). We use time to SEN provision as an indicator of timely support, assuming that all in our population should receive some form of support. We will use survival analysis to quantify differences in time-to-SEN provision, separately for each socio-demographic factor (region, deprivation, gender, English as an additional language and racial-ethnic group). We will express these comparisons in terms of hazard ratios, controlled for cohort, chronic conditions, sex, year, age at cerebral palsy diagnosis, and age at entry into school. Ethical approvals for the ECHILD project are described in this protocol. Findings will be disseminated through peer-reviewed publications, presentations and short briefing reports. The aim of this research is to see whether there are differences in the timing of getting special educational needs (SEN) provision for children with cerebral palsy. Cerebral palsy is a condition caused by a problem with the brain that develops before, during or soon after birth. Cerebral palsy causes problems with movement, co-ordination and, in some cases, difficulties with learning. Children with cerebral palsy are likely to need additional support for learning in school. We will use information collected by schools for all children with cerebral palsy who were born in England between 2003 and 2013. We will explore whether there are differences in the timing of SEN provision by child characteristics, including the region where they live, how deprived their local area is and their ethnicity. The results will help us to understand variation in the timing of special educational needs provision is in England. Our findings can offer insight into potential inequalities in provision and shape policy recommendations around improving pathways to SEN provision. administrative data; cerebral palsy; children; primary school; special education; ECHILD database; inequalities Corresponding Author(s) Grant information: This project is funded by the National Institute for Health and Care Research (NIHR) under its [Programme Grants for Applied Research Programme (Grant Reference Number NIHR202025)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The ECHILD Database uses data from the Department for Education (DfE). The DfE does not accept responsibility for any inferences or conclusions derived by the authors. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. This research contributes to but was not commissioned by the NIHR Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Lewis KM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Lewis KM, Nguyen VG, Zylbersztejn A et al. Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:39 (https://doi.org/10.3310/nihropenres.13618.1) First published: 09 Jul 2024, 4:39 (https://doi.org/10.3310/nihropenres.13618.1) Latest published: 09 Jul 2024, 4:39 (https://doi.org/10.3310/nihropenres.13618.1) Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The ECHILD Database uses data from the Department for Education (DfE). The DfE does not accept responsibility for any inferences or conclusions derived by the authors. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. This research contributes to but was not commissioned by the NIHR Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In state-funded schools in England, children are entitled to receive special educational needs (SEN) provision if they have “a significantly greater difficulty in learning than the majority of others of the same age, or have a disability which prevents them from making use of facilities generally provided by mainstream schools”1. The current iteration of SEN provision falls under two categories: SEN support, which is classroom-based support arranged and funded by schools; and Education Health and Care Plans (EHCPs), which are arranged and funded by local authorities, for children whose needs cannot be met by SEN support. This provision is intended to promote inclusion and improve educational attainment, as well supporting health and wellbeing of children and young people1. SEN legislation emphasises justifiable and fair service provision1, however, there is limited quantitative evidence assessing equity in SEN provision. Studies using administrative educational data report differential rates of SEN provision by sociodemographic characteristics including socioeconomic background, ethnicity, gender and geographical location2–4. However, due to (mostly unmeasured) variation in the underlying need for SEN provision—that causes of which are shaped by wider structural and social factors—5,6, the extent to which differences represent inequities in the assignment of SEN provision are uncertain. To our knowledge, only a limited number of studies have utilised information from external (i.e. not administrative educational data) sources to try to understand disproportionality in SEN provision7,8. For example, a study of children in pre-school in 1997–1999 found that children born in summer months were more likely to be identified in school as requiring SEN provision compared with assessment-based measures that took account of the influence of developmental age on attainment, highlighting the impact of social constructs (i.e. timing of the start of school year) on the allocation of SEN provision8. Recent research has begun to utilise linked health-education datasets to describe differences in SEN provision amongst children with major congenital anomalies9, highlighting the potential for using health phenotypes as a marker of underlying need for SEN provision. In this study, we will also focus on children with comparable health profiles, advancing the current literature in two ways: by looking at the timing to SEN provision, rather than SEN provision at one point in time; and separately studying SEN support and EHCPs, which have different pathways to assignment10. Using national linked health-education data from ECHILD, the aim of this study is to compare time-to-first recorded SEN provision (overall and, separately, for SEN support and EHCPs) by sociodemographic factors for children with hospital-record defined cerebral palsy. Cerebral palsies are a group of movement disorders with multiple aetiologies, with over 90% of cases thought to develop before the first few weeks of life11. The predominant effect of cerebral palsy is on an individual’s movement, posture and balance, although co-existing health problems are common, including executive functioning difficulties and epilepsy12. Children with cerebral palsy are likely to need adjustments at school to aid learning, such as specialist seating, equipment and 11–13. We use time to recording of SEN provision as an indicator of timely support, assuming that all children in our population should receive some form of support. This study is part of a wider programme of work called Health Outcomes for People in Education (HOPE)10. At the outset of HOPE, we consulted with stakeholders, including parent/carers of children who have applied for SEN provision. These consultations revealed frustration at the variation in timing and provision of SEN services, particularly for parents and carers who disproportionately lacked resources to advocate for their child(ren). These discussions led us to design this study to investigate inequities in the timing of SEN provision. Presentation and dissemination of the study's findings will be informed by the HOPE study steering committee, which includes parents of children with disabilities and learning difficulties. Series of staggered cohorts constructed using linked de-identified child-level administrative health and educational records from England. This study will use the ‘Education and Child Health Insights from Linked Data’ (ECHILD) database14, which is comprised from de-identified population-based linked administrative hospital and school/social care records for children and young people in England. The health records used in this study are derived from Hospital Episode Statistics Admitted Patient Care (HES APC), which contains records of all National Health Service (NHS)-funded inpatient hospital activity in England, including records for approximately 97% of births in England15. ECHILD also contains other HES datasets containing contacts with hospital outpatient and accident emergency departments. Educational records are derived from the National Pupil Database (NPD), which contains pupil- and school-level information16. The primary source of information in NPD is the termly School Census (collected in October, January and May each academic year), which contains information on pupil enrolment, absences and exclusions and SEN provision from state-funded mainstream schools, special schools and some alternative provision. Nursery schools, which specialise in education for children aged between 3 and 5 years old, are included in the School Census if attached to a state-funded school. Other NPD modules include the early years census, exam attainment, alternative provision census, pupil referral unit census (collected until 2012/13, after which it was merged with the School Census) and children’s social care. Individual records in HES and NPD are linked by NHS England using deterministic algorithms based on name, date of birth, sex and postcode14. Our population will consist of singleton children with hospital-record defined cerebral palsy born in an NHS hospital in England between 1 September 2003 and 31 August 2013 and recorded as entering a state-funded mainstream or special primary school or alternative provision in England in the January census of nursery year 2, reception, or year 1. The expected age at entry for each of these school years ranges from 3 to 5 years (see Figure 1). Births will be identified in HES APC using a combination of diagnostic and procedure codes, healthcare resource group codes and administrative variables (as outlined in Zylbersztejn et al.)17. We will exclude multiple births (defined in HES APC data) and non-matches in the recording of year and month of birth in HES APC and NPD to minimise the risk of including erroneous links17. Cerebral palsy will be defined by any hospital admission before entry into each staggered school cohort with an International Classification of Diseases 10th Revision (ICD-10) code G80.*, including all subtypes, in any of the 20 diagnoses fields18. We will create three cohorts, corresponding to different points of entry into state-funded primary school: nursery year 2 (hereafter referred to as ‘nursery’; pupils expected to be age 3 years by start of school year), reception (pupils expected to be age 4 years by start of school year); and year 1 (pupils expected to be age 5 years by start of school year), Figure 2. In England, school attendance is compulsory from the age of 5 years, which means that, depending on their date of birth, children are required to enter school at some point between reception and year 1. For each pupil, start of follow up will be set as the day before their first appearance in a January census (in nursery, reception or year 1). Pupils will be followed up until the first chronological event of: first recorded SEN provision (if using survival analyses, see statistical analysis section), the day after the January census in year 6 (the last year of primary school, pupils aged 10/11 years), loss to follow up, or end of study (the day after the January census in 2019). Loss to follow up is defined by non-appearance in any NPD school census following entry into the study. Apart from death, reasons for non-appearance are not recorded in this study, but may include transfer to a non-state funded school, off-rolling (where pupils are illegally excluded from school)19, emigration and death. Permissions to use linked, de-identified data from Hospital Episode Statistics and the National Public Database were granted by DfE (DR200604.02B; 05/08/2020) and NHS Digital (DARS-NIC-381972-Q5F0V-v0.5; 03/09/2020). Ethical approval for the ECHILD project was granted by the National Research Ethics Service (17/LO/1494), NHS Health Research Authority Research Ethics Committee (20/EE/0180) and UCL Great Ormond Street Institute of Child Health’s Joint Research and Development Office (20PE06/20PE16). Consent from patients is not required here. The outcome is recorded SEN provision defined at January census from school entry to year 6 (ages 3/4 to 10/11 years) of the early years census, School Census, alternative provision census and pupil referral unit census. The School Census is also collected in November and March; however, we use the January census only as the information recorded in this census is used to determine funding (and is therefore more likely to contain complete information). We define two categories of SEN provision: SEN support (including previous versions called School Action and School Action Plus), which is arranged by the school and includes classroom based support such as different educational materials or small group support; and Education, Health and Care Plans (EHCPs; including statements of SEN), which are arranged by local authorities for children whose needs cannot be met by the lower level of provision and may include one-to-one support in the classroom and therapies outside school. SEN provision will be classified as a binary (no SEN provision or any SEN provision) and categorical variable (no SEN provision, SEN support only or an EHCP) in this study. We will present the results by the following sociodemographic characteristics of the pupil, which have been selected due to their documented association with SEN provision from peer reviewed and policy evaluation literature2,4,20. In this study, these characteristics are included as indicators of social strata that, through structural inequities in power, money and resources, shape access (and barriers) to timely interventions, such as SEN provision21,22. The following characteristics are measured in NPD at the pupil’s first appearance in a January school census: region of residence (East of England, East Midlands, London, Midlands, North East, North West, South East, South West, West Midlands, Yorkshire and the Humber); income deprivation affecting children index (IDACI) quintile based on residential address; free school meal (FSM) eligibility (yes or no); parent submitted gender (female or male); and English as an additional language (yes, no or unknown). Notably, English as an additional language does not indicate a student’s proficiency in England, and we use this variable as a proxy for minority ethnic groups, where their cultural language is other than English23. We also include child’s racial-ethnic group, which is defined as their latest non-missing recording of ethnicity across NPD censuses. We use racial-ethnic group as a proxy for lived experience of minority ethnic individuals in a White British country. As such, we aim to conduct analysis at the highest level of detail possible; however, grouping ethnicity variables may be necessary due to small numbers, restrictions in answer options provided and/or documentation error. We include the following covariates from HES APC birth records: sex (female or male) as assigned by physician at birth; year of birth, defined according to the academic calendar (e.g. 2003/04 includes 1 September 2003 to 31 August 2004, inclusive); and month of birth. We will define a series of comorbidities using diagnoses in hospital admission records from birth until study entry, based on the Hardelid chronic conditions list24. We will classify local authority based on the home address of each pupil at first appearance in an NPD census. We will create a variable “time since school entry”, calculated as the day before a pupil’s first appearance in a January census minus their entry date into school. This is to account for differences (mainly pre-year 1) in the date a child begins school and their first possibility of having SEN assigned/recorded (i.e. the January census). We will also generate “age at first cerebral palsy recording”, calculated as the date of the pupil’s first recording of cerebral palsy in HES APC minus the date of their birth admission. Table 1 describes our strategies to address potential sources of bias in this study. We will firstly estimate the prevalence of cerebral palsy in our study and externally validate this using national estimates from other data sources13. We will plot the prevalence by year of birth and by age of first recording in HES APC records to assess potential biases in our study introduced by using hospital admission records to define cerebral palsy. We will then describe the characteristics of our study population, including missing data, in numbers and percentages. The association between exposures/covariates and the probability of missingness in at least one study variable will be explored using univariable logistic regression. These findings will be used to decide how to treat missing data in this study. We will describe transitions between no SEN provision, SEN support and EHCPs for pupils as they go through each year of school using a transition matrix and alluvial plots. We will use this information to decide on the precise number of transitions to be modelled in this study. Due to the high support needs of the population, we expect that there will be three transitions at most (study entry to SEN support, study entry to EHCP and SEN support to EHCP, Figure 3). In all cases, we will firstly model time-to-any SEN provision (either SEN support or EHCP) using single-event survival analysis (Figure 3A), which we describe below. These methods will be extended to competing risk survival analysis and multi-state modelling (Figure 3B and 3C, respectively) based on the results of this exploratory step. We will use Cox proportional hazards regression models separately for each exposure of interest (region, IDACI quintile, FSM eligibility, gender and ethnic group) to quantify differences in time-to-first SEN provision between groups. We will consider alternative statistical models if the proportional hazards assumption (tested using Schoenfeld residuals)25 is found to be violated. We will include co-morbidities, sex, year of birth, month of birth and time since school entry to increase precision in estimates, given the documented association between these covariates and the allocation of SEN provision, using stratified Cox models if proportionality for these variables is violated2,4,20. Sex will not be included in the model with gender as the exposure given the high collinearity between these two variables. We will include age at first cerebral palsy recording and subtypes of cerebral palsy (denoted by asterisks in Table 2) as additional covariates to capture severity of cerebral palsy. We will also examine whether there is evidence of effect modification by including interaction terms between cerebral palsy subtypes and each exposure. To account for geographical clustering of SEN provision, analyses will be clustered by local authority of the child’s address at entry into school using the marginal (robust variance estimator) approach. | ICD-10 code | Condition | Included in main analyses | Included in sensitivity analyses | |---|---|---|---| | G80 Cerebral palsy | ||| | G80.0 | Spastic quadriplegic cerebral palsy* | Yes | Yes | | G80.1 | Spastic diplegic cerebral palsy* | Yes | Yes | | G80.2 | Spastic hemiplegic cerebral palsy* | Yes | Yes | | G80.3 | Dyskinetic cerebral palsy* | Yes | Yes | | G80.4 | Ataxic cerebral palsy* | Yes | Yes | | G80.8 | Other cerebral palsy* | Yes | Yes | | G80.9 | Cerebral palsy, unspecified* | Yes | Yes | | G81 Hemiplegia | ||| | G81.0 | Flaccid hemiplegia | Yes | | | G81.1 | Spastic hemiplegia | Yes | | | G81.9 | Hemiplegia, unspecified | Yes | | | G82.0-G82.5 Paraplegia and tetraplegia | ||| | G82.0 | Flaccid paraplegia | Yes | | | G82.1 | Spastic paraplegia | Yes | | | G82.3 | Paraplegia, unspecified | Yes | | | G82.3 | Flaccid tetraplegia | Yes | | | G82.4 | Spastic tetraplegia | Yes | | | G82.5 | Tetraplegia, unspecified | Yes | | | G83.0-G83.3 Diplegia and monoplegia | ||| | G83.0 | Diplegia of upper limbs | Yes | | | G83.1 | Monoplegia of lower limb | Yes | | | G83.2 | Monoplegia of upper limb | Yes | | | G83.3 | Monoplegia, unspecified | Yes | | | G83.8 | Other specified paralytic syndromes | Yes | | | G83.9 | Paralytic syndrome | Yes | We will stratify analyses by cohort and then examine whether estimates can be averaged using a meta-analytical approach, including visualisation via forest plots. The results will be reported in terms of adjusted hazard ratios (aHRs) for each year after school entry, representing the cumulative “relative risk” of recorded SEN provision for each value of each exposure compared with its baseline. For example, we will present the aHR for children eligible for FSMs compared with those not eligible for FSMs after 1 to 7 years. We will graphically present unadjusted cumulative incidence curves of first recorded SEN provision by region of residence, IDACI quintile, FSM eligibility, ethnic group and gender to depict the cumulative probability of an initial recording of any SEN provision. We will also present cumulative incidence curves adjusted for the covariates outlined above using the method outlined by Hernán26. Statistical analyses will be conducted using Stata v17 in the Office for National Statistics Secure Research Service (ONS SRS). R is a suggested opensource alternative. The code and algorithms used in this study will be made publicly available on GitHub when the full study is published. We will conduct two sensitivity analyses to check robustness in our case definition of cerebral palsy using hospital admission records. Whilst cerebral palsy is generally detected by age two/three years27, diagnosis occurs in specialist paediatric settings and the first recording of cerebral palsy in hospital admission records may happen at a later age. In our first sensitivity analyses, we will alter our population to include children who have cerebral palsy first recorded in HES APC records any time before January census in year 6 (ages 10/11 years). To reduce the possibility of including cases where SEN provision may lead to cerebral palsy diagnosis, we will exclude children who have a record of SEN provision before their first recorded cerebral palsy in HES APC. Secondly, we will repeat the main analyses on a population of children defined using a wider definition of cerebral palsies (as has been applied elsewhere)18. We will include children with hospital-record defined cerebral palsy (G80.*), hemiplegia (G81.*), paraplegia and tetraplegia (G82.0-Q82.5), diplegia (G83.0) and/or monoplegia (G83.1-Q83.3), see Table 218. In a third sensitivity analysis, we will examine the extent to which SEN provision may have been assigned prior to school start (as defined in our study). Of the children in the cohort with records in the early year's census or at age 2 in the School Census, we will describe the number and proportion with a recording of SEN support or EHCP before the school start date assigned in our study. We do not use these entry points into education in the main analysis because of variation in the uptake, and data collection, of early years’ placements28. Permissions to use linked, de-identified data from Hospital Episode Statistics and the National Public Database were granted by DfE (DR200604.02B; 05/08/2020) and NHS Digital (DARS-NIC-381972-Q5F0V-v0.5; 03/09/2020). Ethical approval for the ECHILD project was granted by the National Research Ethics Service (17/LO/1494), NHS Health Research Authority Research Ethics Committee (20/EE/0180) and UCL Great Ormond Street Institute of Child Health’s Joint Research and Development Office (20PE06/20PE16). Consent from patients is not required for HES as the data provided by NHS Digital is pseudo-anonymised and reduces identifiability to researchers; further information on opting out of Hospital Episode Statistics for secondary usage can be found here. We gratefully acknowledge all children and families whose de-identified data are used in this research. We would like to acknowledge the contribution of the wider HOPE study team to this work: Kate Boddy, Ayana Cant, Johnny Downs, William Farr, Tamsin Ford, Ruth Gilbert, Laura Gimeno, Katie Harron, Ananya Khera, Matthew Lilliman, Stuart Logan, Jacob Matthews, Jugnoo Rahi, Jennifer Saxton, Antony Stone and Isaac Winterburn. We thank Ruth Blackburn, Matthew Jay and Farzan Ramzan for ECHILD Database support. Faculty Opinions recommendedReferences - 1. Department for Education: Special educational needs and disability code of practice: 0 to 25 years. 2015; (accessed Aug 12, 2023). Reference Source - 2. Strand S, Lindorff A: Ethnic disproportionality in the identification of high-incidence special educational needs: a national longitudinal study ages 5 to 11. Except Child. 2021; 87(3): 344–68. Publisher Full Text - 3. Roman-Urrestarazu A, van Kessel R, Allison C, et al.: Association of race/ethnicity and social disadvantage with autism prevalence in 7 million school children in England. 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Reference Source Author details Author details 1 Great Ormond Street Institute of Child Health, University College London, London, England, WC1N 1EH, UK 2 Institute for Global Health, University College London, London, England, WC1N 1DP, UK 3 Social Research Unit, University College London, London, England, WC1H 0AL, UK 2 Institute for Global Health, University College London, London, England, WC1N 1DP, UK 3 Social Research Unit, University College London, London, England, WC1H 0AL, UK Kate M Lewis Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Vincent G Nguyen Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Conceptualization, Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Ania Zylbersztejn Roles: Data Curation, Writing – Review & Editing Roles: Data Curation, Writing – Review & Editing Sorcha Ni Chobhthaigh Roles: Writing – Review & Editing Roles: Writing – Review & Editing Lorraine Dearden Roles: Funding Acquisition, Writing – Review & Editing Roles: Funding Acquisition, Writing – Review & Editing Bianca De Stavola Roles: Funding Acquisition, Writing – Review & Editing Roles: Funding Acquisition, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This project is funded by the National Institute for Health and Care Research (NIHR) under its [Programme Grants for Applied Research Programme (Grant Reference Number NIHR202025)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The ECHILD Database uses data from the Department for Education (DfE). The DfE does not accept responsibility for any inferences or conclusions derived by the authors. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. This research contributes to but was not commissioned by the NIHR Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The ECHILD Database uses data from the Department for Education (DfE). The DfE does not accept responsibility for any inferences or conclusions derived by the authors. This work contains statistical data from ONS which is Crown Copyright. The use of the ONS statistical data in this work does not imply the endorsement of the ONS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. This research contributes to but was not commissioned by the NIHR Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright © 2024 Lewis KM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Lewis KM, Nguyen VG, Zylbersztejn A et al. Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:39 (https://doi.org/10.3310/nihropenres.13618.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Jul 2024 Views 0 How to cite this report: Asuman D. Reviewer Report For: Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:39 (https://doi.org/10.3310/nihropenres.14783.r34908) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-39/v1#referee-response-34908 https://openresearch.nihr.ac.uk/articles/4-39/v1#referee-response-34908 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 02 Apr 2025 Approved VIEWS 0 The authors aim to study sociodemographic variations in the timing of recodred special educational needs of child with Cerebral Palsy using linked health and education data. The authors propsoe to study a topic of great relevance towards inclusive education ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close The authors aim to study sociodemographic variations in the timing of recodred special educational needs of child with Cerebral Palsy using linked health and education data. The authors propsoe to study a topic of great relevance towards inclusive education using for persons with early-onset disabilities. I have two suggestions for the authors to consider; First, data from health records have been showed to overestimate the prevalence of cerebral palsy. As such, the authors should be guide to exclude individuals with other diagnosis that may be incompatinle with CP. Second, there is a wide variation in function and severity among persons with CP. As such, the authors could consider variations within the population with CP along severity of impairment or other comorbidities. I have two suggestions for the authors to consider; First, data from health records have been showed to overestimate the prevalence of cerebral palsy. As such, the authors should be guide to exclude individuals with other diagnosis that may be incompatinle with CP. Second, there is a wide variation in function and severity among persons with CP. As such, the authors could consider variations within the population with CP along severity of impairment or other comorbidities. - Is the rationale for, and objectives of, the study clearly described? Yes - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Yes - Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health economics; economics of disabilities CITE HOW TO CITE THIS REPORT Asuman D. Reviewer Report For: Sociodemographic variation in the timing of recorded special educational needs provision in primary school in England amongst children with cerebral palsy: a staggered cohort study using the ECHILD database [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:39 (https://doi.org/10.3310/nihropenres.14783.r34908) The direct URL for this report is: https://openresearch.nihr.ac.uk/articles/4-39/v1#referee-response-34908 https://openresearch.nihr.ac.uk/articles/4-39/v1#referee-response-34908 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | | |---|---| | 1 | | | Version 1 09 Jul 24 | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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