Deborah Brauser

September 15, 2016

LONDON — Having parents with multiple sclerosis (MS) does not appear to burden teens when it comes to educational achievement. In fact, these students often achieve higher grades than their peers with healthy parents, new research suggests.

A Danish registry-based cohort study examined more than 4000 offspring of parents with MS and compared them with more than 33,000 children of parents without MS. It showed that mean grades on a ninth-class "basic school" final exam, when the kids were around 15 years of age, were significantly higher in the former than in the latter group.

Although not statistically significant, there was also a trend toward more of the offspring of parents with MS eventually achieving an education focused on healthcare, including physiotherapy, occupational therapy, psychology, and nursing.

Julie Yoon Moberg, PhD student, Danish MS Center, Department of Neurology at Rigshospitalet, Copenhagen, Denmark, presented the results here at the Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2016.

"This was an excellent overview and gives insights into the effect of MS on more than just the patient. It's a perfect example of the importance of being inclusive of the whole family," session cochair Karen Vernon, consultant MS nurse at Salford Royal NHS Foundation Trust, United Kingdom, told Medscape Medical News.

She called the "educational edge" that kids of parents with MS appear to have a pleasant surprise — especially because these parents often carry a lot of guilt and worries about overwhelming their children. "So it's nice to hear about some good news for them."

Linked Registries

Dr Moberg noted that the investigators found 52 previous studies, most using an interviewing design, which examined effects of parental MS status on their kids.

"Many showed a negative impact, especially with too many responsibilities, anxiety and depression, and maladjustment," she said. "And a few showed a positive impact, with more empathy, stronger family bonds, and pride in their caretaking skills."

For the current study, the researchers examined data from the Danish MS Registry for 4177 children of a least one parent with MS. They were then matched 1:8 by year of birth and sex to a group of offspring with neither parent having MS. Participants in this latter group were randomly drawn from the country's Civil Registration System (n = 33,416).

These registries were also linked to Denmark's Population Education Register and the School Grade Register.

Only one child from a chosen family was included in the study, and all of the children were born between 1955 and 1998. Most parents were aged 20 to 29 years at their offspring's birth. The median age of the offspring included in this study was 44 years. In 2013, 88% of these participants were aged 30 to 58 years.

The ninth class in basic school was chosen for evaluation of grades because it's the last class that all Danish kids must finish by law, reported Dr Moberg.

Results showed that on the basic school final exam, the mean grade point difference was 0.46 higher in the MS than in the non-MS offspring groups (95% confidence interval [CI], 0.22 - 0.69; P = .0002).

In addition, the boys of parents with MS had significantly higher exam grades than the boys of parents without MS (difference, 0.61; P = .0008), as did the girls of parents with MS (difference, 0.52; P = .005).

"Hence, the educational attainments do not appear hampered by having a parent with MS," note the investigators.

Positive Message for Families

At older ages and at higher education levels, there were no longer any significant between-group differences in grades achieved. "So these older MS offspring didn't have higher grades, but they also didn't have lower grades, which is a good thing," commented session chair Vernon.

There was a nonsignificant trend toward more health-related education attainment by the MS offspring who were aged 21 to 58 years (odds ratio, 1.1; P = .06). But this type of education was significantly greater when investigators examined just the girls of parents with MS (P < .02).

Dr Moberg told meeting attendees that strengths of the study included that the investigators "weren't dealing with questionnaires and faulty memories." Limitations included lack of adjustments for parental employment or income.

During the postpresentation question-and-answer session, Vernon asked about why the grades were higher in the MS offspring.

"We think this was possibly because of two opposite reasons," answered Dr Moberg. First, some of the offspring reported having a harsh home life with many struggles because of a parent not working. "So they wanted to achieve more for themselves," she said.

"The other possibility is that many of the parents were home a lot and offered a lot of support, including pushing that homework get done and talking about the importance of education."

Vernon noted that both of those reasons make sense. "Using problems as motivation or using a nurturing home life can lead to the same results. For whatever reason, children have resilience. And that had to come from parents in some way."

She added that she would have liked more information as to whether these children of MS parents were specifically targeted by educators for extra help.

"But overall, I found the results to be excellent. It's a very memorable research project with a positive message that we can give to families."

The study was funded by the Danish Multiple Sclerosis Society and the Karen A. Tolstrup Foundation. Dr Moberg has served on a scientific advisory board for Biogen and received support for congress participations from Teva Pharmaceutical Industries and Biogen. Ms Vernon reported support in respect to education and advisory boards "from most of the major companies" but has no conflicts with the current study.

Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2016. Nurses' session 1, oral presentation 65. Presented September 14, 2016.

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