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Original research
Impact of co-occurring hearing and visual difficulties in childhood on educational outcomes: a longitudinal cohort study
  1. Matilda Hill1,
  2. Amanda Hall2,
  3. Cathy Williams1,
  4. Alan M Emond1
  1. 1 Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
  2. 2 School of Life and Health Sciences, Aston University, Birmingham, UK
  1. Correspondence to Dr Matilda Hill; matildahill84{at}


Background Mild hearing and visual difficulties are common in childhood, and both may have implications for educational achievement. However, the impact of co-occurring common hearing and visual difficulties in childhood is not known.

Objective To determine the prevalence and impact of co-occurring common hearing and visual difficulties of childhood on educational outcomes in primary and secondary school.

Methods The sample was drawn from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort study in England. The exposures were hearing and visual difficulties at age 7 (defined as conductive hearing loss or otitis media with effusion, and amblyopia, strabismus or reduced visual acuity, respectively). The outcomes measured were achievement of level 4 or above at Key Stage 2 (KS2) in English, Maths and Science, respectively, at age 11, and attainment of five or more General Certificate of Secondary Education (GCSEs) at grades A*–C at age 16. Multiple logistic regression models assessed the relationship between hearing and visual difficulties and educational outcomes, adjusting for potential confounding factors.

Results 2909 children were included in the study; 261 had hearing difficulties, 189 had visual difficulties and 14 children had co-occurring hearing and visual difficulties. Children with co-occurring hearing and visual difficulties were less likely to achieve the national target at KS2 compared with children with normal hearing and vision, even after adjustment for confounding factors (OR 0.30, CI 0.15 to 0.61 for KS2 English). Differences in IQ, behaviour, attention and social cognition did not account for this relationship. The impact of co-occurring hearing and visual difficulties on GCSE results was explained largely by poor performance at KS2.

Conclusions Co-occurring hearing and visual difficulties in childhood have an enduring negative impact on educational outcomes. Identification of affected children and early intervention in primary school is essential.

  • comm child health
  • ophthalmology
  • audiology
  • epidemiology
  • paediatric practice

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors The study was designed jointly by MH, AME, AH and CW. MH carried out the data analysis and wrote the initial draft. AME, AH and CW contributed equally to revisions of the draft.

  • Funding The UK Medical Research Council, the Wellcome Trust (grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website:

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the local research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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