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Limitations. The cross-sectional design (with observations made at only one point in time) of most studieslimits the weight of evidence for establishing linkages. Only one longitudinal study (with multipleobservations made over time) was found, where academic performance was measured on more than oneoccasion (Kovacs et al., 1992). Overall, sample sizes for the studies reviewed above were small, from 20to 100 children, with two studies including 200 or more subjects (McCarthy et al., 2003; McCarthy et al.,2002). Control groups typically have been used to account for different background experiences andenvironments. Some studies used siblings and others selected control groups to be demographicallycomparable in age, gender, lack of other diseases, child’s education level and parents’ socioeconomicstatus (SES). Other studies, however, did not adjust for such variables, even when differences were seenbetween groups (Ack et al., 1961; McCarthy et al., 2002). Samples were typically restricted to children ofwhite ethnicity, even though, as a group they tend to receive the highest grades. Any attempt togeneralize from these findings to other, more diverse populations is therefore of limited value.Implications. In summary, there is evidence that diabetic children may show subtle reductions inneuropsychological functioning. The importance of this to long-term academic achievement and learninghas not been thoroughly explored. Diabetic children have a tendency to be absent more often, related todisease symptoms, and to have lower academic performance over time, particularly in reading. Most ofthese studies, however, have design flaws that limit the weight that should be assigned to their findings.DepressionPrevalence. A depressed mood affects approximately four out of ten young people during any six-monthperiod, while prevalence of major depressive disorder ranges from 0.4 to 6.6% (Anderson J., McGee, R.,1994; Fleming & Offord, 1990; Kashani et al., 1987; Lewinsohn et al., 1994; Lewinsohn et al., 1993). Aninvestigation of an ethnically diverse sample of Texas middle-school students found an overall prevalenceof 8.4% for major depression without impairment and 4.3% with impairment (Roberts et al., 1997). Ofthose with impairment, students of Chinese descent had the lowest prevalence (1.9%) while those ofMexican ancestry had the highest prevalence (6.6%). When a sample of ninth grade students from theTexas Lower Rio Grande Valley were evaluated, the prevalence of major depression and anxiety wereboth reported as 3.1% (Roberts et al., 2002).Depression and Academic Performance. The relationship between depression and anxiety and academicfunctioning among school children may operate in a cyclical fashion, both as risk factors andconsequences of poor academic performance (Birmaher et al., 1996). Longitudinal research suggeststhat self-reported depressed mood among children, as early as the first grade, has been found to bepredictive of their attention and concentration in the classroom in the short term (Edelsohn et al., 1992), oftheir academic functioning (grade point average and grade retention) in sixth grade, and of majordepressive disorder in eighth grade (Ialongo et al., 2001). In adolescence, depression has been found tobe related to grade point average and time spent doing homework (Field et al., 2001), to be preceded bydissatisfaction with grades and to result in school absenteeism (Lewinsohn et al., 1994). Using a twowavelongitudinal design, Rudolph, et al., (Rudolph et al., 2001) reported that academic disengagementrelated to transition to middle school was linked to increased school-related stress; and that increasedschool-related stress was subsequently linked to increases in depressive symptoms. Their additionalfinding that maladaptive self-regulatory beliefs were associated with low levels of academic engagementdoes suggest possible intervention strategies to prevent depression involving school-related issues.Cross-sectional data from a nationally representative sample, aged 10-18, suggests that youth withhigh levels of depressive symptoms missed approximately 1 day more of school per month than childrenand youth with lower levels of depressive symptoms (Glied & Pine, 2002). Breuner, et al., (Breuner et al.,2004) report an association, from their retrospective study of 283 adolescents recruited through aheadache clinic, between poorer school grades, symptoms of depression, and school absences.Headaches, anxiety symptoms were not found to be related to attendance. A small cross-sectional studyamong 79 high school seniors found that the group of adolescents who scored above the clinical cutoff fordepression on a self-report measure spent less time doing homework and had a lower grade pointE-9