Transcript Poor School Performance Dr. Sunil Karande

Poor School Performance
Dr. Sunil Karande
Professor of Pediatrics &
In-Charge Learning Disability Clinic
Department of Pediatrics
Seth G.S. Medical College & K.E.M. Hospital
Parel, Mumbai.
Introduction
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~20% of children in a classroom get poor marks - they are
“scholastically backward”
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“Symptom” reflecting a larger underlying problem in children
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Results in child having a low self-esteem
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Significant stress to parents
TLDF 2011
Sunil Karande
Causes of Scholastic Backwardness
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Medical problems
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Below average intelligence
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Specific learning disability (SpLD)
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Attention-deficit hyperactivity disorder (ADHD)
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Emotional problems
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Poor socio-cultural home environment
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Psychiatric disorders
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Environmental causes
TLDF 2011
Sunil Karande
Medical Problems
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Preterm birth
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Low birth weight
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Malnutrition
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Worm infestation
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Hearing impairment (e.g. otitis media)
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Visual impairment (e.g. refractive error)
TLDF 2011
Sunil Karande
Medical Problems
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Asthma
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Hemophilia
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Allergic rhinitis
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Diabetes Mellitus
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Epilepsy (& AEDs)
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Hypothyroidism
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Cerebral Palsy
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Sleep disordered
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Leukemia
breathing (habitual
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Thallasemia major
snoring)
TLDF 2011
Sunil Karande
Below average intelligence
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Intelligence (IQ score): most important prognostic variable
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Borderline intelligence or “slow learners” (IQ 71 to 84)
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Mental retardation (IQ ≤ 70) e.g. Down syndrome
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Risk factors: prematurity, meningitis, severe head injury
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Usually have history of delayed milestones
TLDF 2011
Sunil Karande
SpLD
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heterogeneous group of disorders
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manifested by significant unexpected, specific and persistent
difficulties in acquisition and use of reading (dyslexia), writing
(dysgraphia) or mathematical (dyscalculia) abilities
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despite conventional instruction, normal intelligence, proper
motivation and adequate socio-cultural opportunity
TLDF 2011
Sunil Karande
What happens in dyslexia?
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Deficits in phonologic awareness
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“Phoneme”: smallest discernible segment of speech
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"bat" consists of three phonemes:
/b/ /ae/ /t/ (buh, aah, tuh)
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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
TLDF 2011
Sunil Karande
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~5-12% school children have dyslexia
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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
TLDF 2011
Sunil Karande
Symptoms of SpLD
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Children with SpLD fail to achieve school grades at a level
that is commensurate with their intelligence
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Repeated spelling mistakes, untidy or illegible handwriting
with poor sequencing, inability to perform simple mathematical
calculations correctly
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Life-long condition
TLDF 2011
Sunil Karande
ADHD
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ADHD affects 8-12% of children
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Results in inattention, impulsivity and hyperactivity
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Some have predominant inattention, some have, impulsivity and
hyperactivity, some have both
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At risk for poor school performance
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20-25% of children with ADHD have SpLD & vice versa
TLDF 2011
Sunil Karande
Autism
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Impairment of reciprocal social interactions
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Impaired communication skills
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Restricted range of interests or repetitive behaviors
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Demonstrate distress and oppositionality when exposed to
requests to complete academic tasks
TLDF 2011
Sunil Karande
Emotional Problems
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Chronic neglect
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Sexual abuse
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Parents getting divorced
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Losing a sibling
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Chronic health impairments
Resulting in low self-esteem & loss of motivation to study
TLDF 2011
Sunil Karande
Poor socio-cultural environment
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Language barrier
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Malnutrition due to poverty
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Low education status of parents
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Parental attitudes which do not motivate them to study
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Unsatisfactory home environment (domestic violence, family
stressors, adverse life events)
TLDF 2011
Sunil Karande
Psychiatric disorders
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Early signs of emerging or existing anxiety, depression or
psychosis
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Conduct disorder and oppositional defiant disorder
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Change in child’s personality
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Deteriorating school performance
TLDF 2011
Sunil Karande
Environmental causes
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Noisy environment
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Unattractive schools
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Too much television viewing (lack of sleep)
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Exposure to lead
TLDF 2011
Sunil Karande
Management of Poor School Performance
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Child may be having ≥1 reason
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Refer early for evaluation
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Information from parents, classroom teachers & school
counselor crucial
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Information should clearly describe child’s academic
difficulties, behavior & social functioning
TLDF 2011
Sunil Karande
Multidisciplinary approach
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Pediatrician
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Ophthalmologist
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Otolaryngologist
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Counselor
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Clinical Psychologist
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Child Psychiatrist
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Special Educator
TLDF 2011
Sunil Karande
Treatment of Medical Problems
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If any specific ‘medical’ reason identified, pediatrician should
treat it as effectively as possible
e.g. optimum control of asthma or epilepsy
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Correction of hearing and/or visual impairment
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Children irrespective of their physical, sensory, or
neurobehavioral deficits, must be educated in regular
mainstream schools (“inclusive education”)
TLDF 2011
Sunil Karande
Treatment of SpLD
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Remedial Education to begin during primary schooling
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Given by Remedial Teacher
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Hourly one to one sessions thrice weekly for few years
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Systematic and highly structured training exercises
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Management of SpLD in secondary school is based more on
providing provisions / accommodations:
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exemption from spelling mistakes
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availing extra time for written tests
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dropping a second language for work experience
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dropping algebra and geometry for lower grade of mathematics &
work experience
TLDF 2011
Sunil Karande
Treatment of ADHD
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Children with ADHD need psychiatric consultation for
counseling, behavior modification, and / or medications,
(methylphenidate or atomoxetine)
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Medications have been shown to be effective in significantly
reducing symptoms of inattention, impulsivity and
hyperactivity
TLDF 2011
Sunil Karande
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Children with emotional problems need counseling sessions with a
child psychologist / psychiatrist
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Medications (anxiolytics, antidepressants) may be needed
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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”
TLDF 2011
Sunil Karande
Prevention of Poor School Performance
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Teachers trained to suspect emotional problems, SpLD, and
ADHD so that they are diagnosed and treated early
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School feeding programs (mid-day meal)
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Regular vision and hearing screening camps in schools
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Good sleeping habits
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Alleviation of poverty
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Proper ante-natal and peri-natal services
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Exclusive breastfeeding up to 6 months
TLDF 2011
Sunil Karande
Thank You
TLDF 2011
Sunil Karande