Research Snapshot: Shaping learning trajectories for children with additional health and developmental needs

Research Snapshot: Shaping learning trajectories for children with additional health and developmental needs

Research Snapshot: Shaping learning trajectories for children with additional health and developmental needs


Children with additional health and developmental needs (AHDN) are those who have, or are at increased risk of chronic physical, developmental, behavioural, or emotional conditions, and need more supports than their peers. Almost one fifth of Australian children in their first year of school experience AHDN: 4 per cent with formally diagnosed conditions and 18 per cent with emerging problems that don’t qualify for special education supports. Children with AHDN begin school with weaker academic skills than their peers, and are at increased risk of poorer educational outcomes including lower rates of high school completion and post-secondary education.

Despite the large numbers of children affected by AHDN, the academic progress of these children over the early school years is not well understood. The concept of cumulative advantage suggests that children with strong early academic skills are better equipped to take advantage of learning opportunities and are poised for academic success. Accordingly, children with AHDN who lack foundational academic skills due to a chronic condition (e.g. chronic illness or autism) may not gain comparable benefit from the same learning opportunities and consequently fall further behind. Socioeconomic disadvantage has also been associated with poorer academic pathways therefore children with AHDN living in disadvantaged communities may be at even greater risk of academic underachievement and school disengagement.


This research aimed to describe the academic trajectories of primary school children with both established and emerging health and developmental conditions. The impact of socioeconomic disadvantage on the relationship between AHDN and academic trajectories was also investigated.

Key findings

Three trajectories (or pathways over time) of academic performance over the primary school years (from ages 4–5 to 10–11) were identified for all children: 25 per cent of children performed steadily above average, 50 per cent of children performed close to average, and the remaining

25 per cent of children performed consistently below average. Children with both established and emerging AHDN were more likely to be in the low or average performing academic trajectory (see Figure 1), as were children from disadvantaged backgrounds. Of the children with emerging AHDN, those who were also disadvantaged were more likely to be in the low trajectory.

Differences in academic development already present at school entry remained stable over time. The effect of cumulative advantage saw children with strong early academic skills continue to improve over time, whilst children who displayed poor early academic skills fell slightly more behind. Nevertheless, poor academic outcomes were not inevitable for children with AHDN - a number of children with AHDN were within the highest performing academic trajectory.


For policy and practice

Our understanding of academic trajectories indicates that early intervention is crucial for children experiencing difficulties to improve their educational pathways.

Ideal are interventions prior to starting school (e.g. during preschool) to minimise or prevent academic difficulties at school. Children experience a wide range of health and developmental conditions which require varying levels and types of support. Interventions most likely to be effective are those tailored to the needs of the individual child. The finding that children with AHDN can have high academic achievement is promising and reinforces the potential of interventions to help these children reach their optimal learning potential. A greater allocation of resources is required for children with AHDN living within socioeconomically disadvantaged settings, to better address the needs of children who are doubly disadvantaged.

Improving the developmental trajectories of children with AHDN depends on collaboration. The education system alone is not equipped to address the complex needs of these children. Multidisciplinary responses coordinated across the school and health-care systems are needed, and health professionals have a major role to play in promoting positive educational outcomes of children with AHDN through the early identification of difficulties.

For research

Previous research examining the academic pathways of children with AHDN has generally grouped children according to their diagnostic categories (e.g. children with learning disabilities). A non-categorical approach, as applied here, can also be helpful in understanding how AHDN can affect children’s academic success. The variety of ways that AHDN can influence school functioning are not constrained by diagnoses, and it is apparent that children with emerging and undiagnosed health and developmental conditions are also at risk of poorer educational outcomes. It is important to include these children when examining the academic outcomes of children with AHDN, given the potential value of early interventions on academic difficulties. Future research should aim to identify modifiable risk and protective factors that can be targeted to reduce the impact of

AHDN on children’s educational pathways and to  positive outcomes. (For further information  the ways that AHDN impact on school functioning, see Research snapshot: Children with additional health and developmental needs at school: Risk and protective factors).

Study details

The Longitudinal Study of Australian Children (LSAC) is a nationally representative sample of two cohorts of Australian children which commenced in May 2004.

Data were analyzed from a subsample of 720 children from the LSAC Kindergarten cohort for whom teachers also completed the Australian Early Development Index checklist ( The AEDC is a measure of early childhood development at school entry that includes AHDN, and also measures five important domains of early childhood development: physical health and wellbeing, social competence, emotional maturity, language and cognitive developmental, communication skills and general knowledge.

For further details

Details of the research paper

For full technical details of this research see: Goldfeld, S., O’Connor, M., Quach, J., Tarasuik, J., & Kvalsvig, A. (2015). Learning trajectories of children with special health care needs across the severity spectrum. Academic Paediatrics, 15(2), 177–184. doi: 10.1016/j.acap.2014.09.001. A full list of references used in the development of this snapshot is available online with this link.

About research snapshots

Research Snapshots provide a brief and accessible overview of research being undertaken in relation to the AEDC. This project was funded by the Australian Government under the AEDC program. For further up-to-date information consult the AEDC website and its many resources.

About the organisation

The Royal Children’s Hospital Centre for Community Child Health (CCCH) has been at the forefront of Australian research into early childhood and behaviour for over two decades. The CCCH conducts research into many conditions and common problems faced by children that are either preventable or can be improved if recognised and managed early. By working collaboratively with leaders in policy, research, education and service delivery, the Centre aims to influence early childhood policy and improve the capacity of communities to meet the needs of children and their families.

Bar graph of academic pathways for children with AHDN (Showing standard population, emerging SHCN and established SHCN.


Bar graph showing academic pathways of children with AHDN according to disadvantage. No children with emerging needs in the lowest SES group were in the high academic trajectory.

Stock code: ED15-0226​​