Poor School Performance

Dr. Sunil KarandeProfessor of Pediatrics &

In-Charge Learning Disability Clinic

Department of Pediatrics

Seth G.S. Medical College & K.E.M. Hospital

Parel, Mumbai.

Sunil Karande

Introduction

• ~20% of children in a classroom get poor marks - they are “scholastically backward”

• “Symptom” reflecting a larger underlying problem in children

• Results in child having a low self-esteem

• Significant stress to parents

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Sunil Karande

Causes of PSP

• Medical problems

• Low intelligence (Slow Learners and Mental Retardation)

• Specific learning disability (SpLD)

• Attention-deficit hyperactivity disorder (ADHD)

• Emotional problems

• Poor socio-cultural home environment

• Psychiatric disorders

• Environmental causes

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Sunil Karande

Medical Problems

• Preterm birth

• Low birth weight

• Malnutrition

• Worm infestation

• Hearing impairment (e.g. otitis media)

• Visual impairment (e.g. refractive error)

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Sunil Karande

Medical Problems

• Asthma

• Allergic rhinitis

• Epilepsy (& AEDs)

• Cerebral Palsy

• Leukemia

• Thallasemia major

• Hemophilia

• Diabetes Mellitus

• Hypothyroidism

• Sleep disordered

breathing (habitual

snoring)

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Sunil Karande

Low Intelligence

• Intelligence (IQ score): most important prognostic variable

• Borderline intelligence or “slow learners” (IQ 71 to 84)

• Mental retardation (IQ ≤ 70) e.g. Down syndrome

• Risk factors: prematurity, meningitis, severe head injury

• Usually have history of delayed milestones

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Sunil Karande

SpLD

• heterogeneous group of disorders

• manifested by significant unexpected, specific and persistent

difficulties in acquisition and use of reading (dyslexia), writing

(dysgraphia) or mathematical (dyscalculia) abilities

• despite conventional instruction, normal intelligence, proper

motivation and adequate socio-cultural opportunity

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Sunil Karande

What happens in dyslexia?

• Deficits in phonologic awareness

• “Phoneme”: smallest discernible segment of speech

• "bat" consists of three phonemes:

/b/ /ae/ /t/ (buh, aah, tuh)

• Poor awareness that: words, both written and spoken, can be

broken down into smaller units of sound; and letters constituting

printed word represent sounds heard in spoken word

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Sunil Karande

• ~5-12% school children have dyslexia

• Red flags for dyslexia:

* history of language delay

* not attending to sounds of words

(trouble playing rhyming games with words, or confusing

words that sound alike)

* positive family history

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Sunil Karande

Symptoms of SpLD

• Children with SpLD fail to achieve school grades at a level

that is commensurate with their intelligence

• Repeated spelling mistakes, untidy or illegible handwriting

with poor sequencing, inability to perform simple

mathematical calculations correctly

• Life-long condition

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Sunil Karande

ADHD

• ADHD affects 8-12% of children

• Results in inattention, impulsivity and hyperactivity

• Some have predominant inattention, some have, impulsivity and

hyperactivity, some have both

• At risk for poor school performance

• 20-25% of children with ADHD have SpLD & vice versa

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Sunil Karande

Autism

• Impairment of reciprocal social interactions

• Impaired communication skills

• Restricted range of interests or repetitive behaviors

• Demonstrate distress and oppositionality when exposed to

requests to complete academic tasks

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Sunil Karande

Emotional Problems

• Chronic neglect

• Parents getting divorced

• Losing a sibling

• Chronic health impairments

• Sexual abuse

Resulting in low self-esteem & loss of motivation to study

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Sunil Karande

Poor socio-cultural environment

• Language barrier

• Malnutrition due to poverty

• Low education status of parents

• Parental attitudes which do not motivate them to study

• Unsatisfactory home environment (domestic violence, family

stressors, adverse life events)

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Sunil Karande

Psychiatric disorders

• Early signs of emerging or existing anxiety, depression or

psychosis

• Conduct disorder and oppositional defiant disorder

• Change in child’s personality

• Deteriorating school performance

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Sunil Karande

Environmental causes

• Noisy environment

• Unattractive schools

• Too much television viewing (lack of sleep)

• Exposure to lead

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Sunil Karande

Management of Poor School Performance

• Child may be having ≥1 reason

• Refer early for evaluation

• Information from parents, classroom teachers & school

counselor crucial

• Information should clearly describe child’s academic

difficulties, behavior & social functioning

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Sunil Karande

Multidisciplinary approach

• Pediatrician

• Ophthalmologist

• Otolaryngologist

• Counselor

• Clinical Psychologist

• Child Psychiatrist

• Special Educator

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Sunil Karande

Treatment of Medical Problems

• If any specific ‘medical’ reason identified, pediatrician should

treat it as effectively as possible

e.g. optimum control of asthma or epilepsy

• Correction of hearing and/or visual impairment

• Children irrespective of their physical, sensory, or

neurobehavioral deficits, must be educated in regular

mainstream schools (“inclusive education”)

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Sunil Karande

Treatment of SpLD

• Remedial Education to begin during primary schooling

• Given by Remedial Teacher

• Hourly one to one sessions thrice weekly for few years

• Systematic and highly structured training exercises

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Sunil Karande

• Management of SpLD in secondary school is based more on

providing provisions / accommodations:

exemption from spelling mistakes

availing extra time for written tests

dropping a second language for work experience

dropping algebra and geometry for lower grade of mathematics &

work experience

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Sunil Karande

Treatment of ADHD

• Children with ADHD need psychiatric consultation for

counseling, behavior modification, and / or medications,

(methylphenidate or atomoxetine)

• Medications have been shown to be effective in significantly

reducing symptoms of inattention, impulsivity and

hyperactivity

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Sunil Karande

• Children with emotional problems need counseling sessions with a

child psychologist / psychiatrist

• Medications (anxiolytics, antidepressants) may be needed

• Parents of children with “language barrier” counseled to educate

their children in their own language medium schools or to attend a

facility for “language stimulation”

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Sunil Karande

Prevention of Poor School Performance

• Teachers trained to suspect emotional problems, SpLD, and

ADHD so that they are diagnosed and treated early

• School feeding programs (mid-day meal)

• Regular vision and hearing screening camps in schools

• Good sleeping habits

• Alleviation of poverty

• Proper ante-natal and peri-natal services

• Exclusive breastfeeding up to 6 months

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Sunil Karande

Thank You

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