With growing numbers of children affected by complex and chronic conditions that can affect learning, the American Academy of Pediatrics (AAP) highlights ways a student's health and well-being can impact educational achievement--and how physicians can help patients struggling at school.
When a child gets sick, a pediatrician diagnoses the illness and recommends treatment. When it's the child's progress at school that's suffering, according to a new AAP report, pediatricians can also play an important role in determining the cause and helping to support the child's success.
The AAP clinical report, "School-Aged Children Who Are Not Progressing Academically: Considerations for Pediatricians," in the October 2019 issue of
Pediatrics, gives pediatricians more tools to help children with psychological and learning difficulties or complex medical problems that can derail expected educational progress. It also highlights approaches for evaluation, treatment, referrals, and strategies to collaborate with families, schools, and other health providers on behalf of the child.
"I've seen how miserable and hopeless kids feel when they're falling behind or failing at school," said Arthur Lavin, MD, FAAP, a co-author of the clinical report and chair of the AAP Committee on Psychosocial Aspects of Child and Family Health. "Our goal is to use our resources as pediatricians to help identify why the child is struggling and provide realistic options to help them succeed in moving forward in their education."
The AAP outlines the variety of health issues and complex, interrelated factors that can contribute to "academic dysfunction." These may include cognitive dysfunctions, emotional difficulties and disorders, autism spectrum disorder, adversity or trauma, stress in important relationships in and out of the home, attention deficits, and physical illnesses.
"Each child is a complex individual and a lack of academic progress is often a symptom of complex issues that need to be approached with careful thought" said child neuropsychologist Celiane Rey-Casserly, Ph.D., a co-author of the report. "They may show up as neurologic, emotional, or behavioral issues--or different combinations of them."
Pediatricians already work with families to help children reach their full academic potential in many ways as they monitor a child's health and development. They may also screen for exposures to environmental toxins such as lead and counsel families about safety measures such as wearing bicycle helmets to prevent traumatic head injury.
When academic problems arise, sometimes they can be addressed with a thorough medical history and interventions during a clinical visit. For example, undiagnosed or poorly controlled chronic illnesses such as asthma and diabetes are associated with worse academic performance. They can also affect sleep quality, creating further problems.
"Creating an action plan to manage a child's symptoms can help them function better at school," said Laura McGuinn, MD, FAAP, a co-author of the report and former member of the AAP Committee on Psychosocial Aspects of Child and Family Health. "Other times," she said, "referrals for psychological and educational evaluations for conditions such as neurodevelopmental and language disorders, learning, and intellectual disabilities, or emotional health issues can help with diagnosis and strategies to address the child's needs."
With information from in-depth assessments, pediatricians can work with the family, school, and other professionals, such as child psychologists, neuropsychologists, speech and language pathologists, occupational therapists, physical therapists, developmental-behavioral pediatricians, child neurologists, and child psychiatrists, to identify a path forward. Pediatricians can also help families request and advocate for the best Individualized Education Program or 504 for the child, ensuring access to resources they need.
"It may seem like an easy option to hold the child back and have them repeat a grade to help them 'catch up' academically, but this can leave children feeling disconnected from school and do more harm than good in the long run," said Dr. McGuinn. In 2016, about 1.9 percent of U.S. elementary through high school students stayed in the same grade they were enrolled in the prior school year, but this percentage has been declining.
"Evidence shows that children are most successful when they are supported to advance grade levels with their peers while we sort out and address possible causes for their academic struggles," Dr. McGuinn said.
"Working together with the family, the school, and other providers in the child's medical home," she said, "we can build a plan to help children with complex academic struggles reach their full potential."
Additional Information from HealthyChildren.org