A new school year has begun, a time of hope for many children and families. For millions of students, however, the school year brings worry and disappointment as they fail to progress academically.
A new AAP clinical report presents the magnitude of the problem and clarifies that there can be a wide range of reasons for each child’s problems. It also discusses the pediatrician’s role in identification and management and serves a reminder that success requires implementation of a treatment plan that addresses individual causes.
The reportSchool-Aged Children Who Are Not Progressing Academically: Considerations for Pediatricians, from the Committee on Psychosocial Aspects of Child and Family Health and Section on Developmental and Behavioral Pediatrics, is available at https://doi.org/10.1542/peds.2019-2520 and will be published in the October issue of Pediatrics.
Differential diagnosis
From 2014-’15, 6.6 million children ages 3-21 years received special education services.
The details of how a child presents to the pediatrician because of struggles in school offer insights into the variety of causes of such challenges. Clues include age and pace of onset; events in the child’s life; and different symptoms for the same cause. For example, a math learning disorder may present with low grades in math, altered mood or lack of focus.
The large numbers of children who are not progressing academically and the complexity of their presentations establish the fundamental need for the pediatrician to consider a differential diagnosis to determine the etiologies that are driving the difficulties. The clinical report presents the inherent mutual inclusivity of causes for a child not doing well in school. Domains of causation include:
- cognitive dysfunctions,
- emotional difficulties and disorders,
- autism spectrum disorder,
- adversity or trauma,
- stress in important relationships in and out of the home,
- physical illnesses and
- attentional deficits.
Pediatricians’ key roles
The report presents opportunities for pediatricians to make a difference in the life of a child not progressing academically. Some of the roles include:
- Prevention of impaired ability to learn. Examples include monitoring growth, immunizing, screening for iron and lead, and recommending safety practices that protect the mind.
- Promotion of protective factors and early problem recognition.
- Diagnosis. Pediatricians’ relationship with families uniquely qualifies them to be the person to synthesize the wide range of considerations that may explain the problems causing a child to struggle academically.
- Implementation of a plan. An understanding of the cause(s) of a child’s difficulties in school serves as the basis for a plan to change struggle to success. Once a plan is crafted, the following steps can help ensure it is executed properly:
- Help the family and school understand the diagnosis and plan.
- Set the expectation that the plan will be implemented.
- Monitor the plan’s translation into moving the child from struggle to success.
- Promote resilience by focusing on the strengths of the child and their community.
The clinical report also includes a list of screening tools and templates of letters pediatricians can use for schools, insurance companies and other health care specialists. There are appendices on coding and billing strategies, tips on understanding test scores and resources for families.
This AAP clinical report helps to set the standard that pediatricians and the teams they work with can help children, even those with the most complex challenges, understand why they are struggling in school and develop plans to help them succeed.
Dr. Lavin is a lead author of the clinical report and chair of the AAP Committee on Psychosocial Aspects of Child and Family Health.
