Poor school performance


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Dr. Karande's presentation at the Tata Learning Disability Forum (TLDF), 2013

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Poor school performance

  1. 1. Poor School Performance Dr. Sunil Karande Professor of Pediatrics & In-Charge Learning Disability Clinic Department of PediatricsSeth G.S. Medical College & K.E.M. Hospital Parel, Mumbai.
  2. 2. 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 parentsForum for LD 2013 Sunil Karande 2
  3. 3. 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 Forum for LD 2013 Sunil Karande 3
  4. 4. Medical Problems• Preterm birth• Low birth weight• Malnutrition• Worm infestation• Hearing impairment (e.g. otitis media)• Visual impairment (e.g. refractive error) Forum for LD 2013 Sunil Karande 4
  5. 5. Medical Problems• Asthma • Hemophilia• Allergic rhinitis • Diabetes Mellitus• Epilepsy (& AEDs) • Hypothyroidism• Cerebral Palsy • Sleep disordered• Leukemia breathing (habitual snoring)• Thallasemia majorForum for LD 2013 Sunil Karande 5
  6. 6. 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 Forum for LD 2013 Sunil Karande 6
  7. 7. 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 Forum for LD 2013 Sunil Karande 7
  8. 8. 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 Forum for LD 2013 Sunil Karande 8
  9. 9. • ~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 Forum for LD 2013 Sunil Karande 9
  10. 10. 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 Forum for LD 2013 Sunil Karande 10
  11. 11. 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 Forum for LD 2013 Sunil Karande 11
  12. 12. 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 Forum for LD 2013 Sunil Karande 12
  13. 13. Emotional Problems• Chronic neglect• Parents getting divorced• Losing a sibling• Chronic health impairments• Sexual abuse Resulting in low self-esteem & loss of motivation to studyForum for LD 2013 Sunil Karande 13
  14. 14. 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)Forum for LD 2013 Sunil Karande 14
  15. 15. 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 performanceForum for LD 2013 Sunil Karande 15
  16. 16. Environmental causes• Noisy environment• Unattractive schools• Too much television viewing (lack of sleep)• Exposure to leadForum for LD 2013 Sunil Karande 16
  17. 17. 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 functioningForum for LD 2013 Sunil Karande 17
  18. 18. Multidisciplinary approach• Pediatrician• Ophthalmologist• Otolaryngologist• Counselor• Clinical Psychologist• Child Psychiatrist• Special EducatorForum for LD 2013 Sunil Karande 18
  19. 19. 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”)Forum for LD 2013 Sunil Karande 19
  20. 20. 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 Forum for LD 2013 Sunil Karande 20
  21. 21. • 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 Forum for LD 2013 Sunil Karande 21
  22. 22. 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 hyperactivityForum for LD 2013 Sunil Karande 22
  23. 23. • 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” Forum for LD 2013 Sunil Karande 23
  24. 24. 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 Forum for LD 2013 Sunil Karande 24
  25. 25. Thank YouForum for LD 2013 Sunil Karande 25