Addressing Academic Challenges

A health article from Dr. John Spitzer, a pediatrician at Bronson Primary Care Partners.

We are heading into the final quarter of the school year, and what a year it has been! The pandemic introduced virtual learning for students back in 2020. We wore masks and practiced social distancing in the classroom when in-person learning did resume, and sports and after-school activities were modified or simply cut out completely. Most students had difficulties adjusting to new learning styles - particularly virtual learning. Why?

• Children have short attention spans - even more so while sitting in front of the computer all day.
• A lack of enthusiasm toward doing homework when already learning from home all day.
• Parents were put into a teaching role at home, which was a major change for so many.

So it is no surprise that grades were not as good as before! And even though schools are back to in-person learning, this school year has also been difficult in its own ways. Despite the many challenges students have faced over the past few years, expectations for school performance are similar to pre-pandemic times. So you as a parent may be left wondering: If your child is still not performing well this year, could there be other learning problems?

See Your Pediatrician For Help

When we see a child or teen in the office for not performing well in school, there are a number of factors that we consider before we come up with a diagnosis and create a plan for improvement. At the most basic level, we want to make sure that hearing and vision are normal. Testing for these can be easily done in the office.

• Motor disabilities, particularly fine motor, can make it difficult for children to focus and perform certain skills like writing. For example, a child with fine motor skills may have difficulty writing notes while their teacher is presenting a slideshow. We will often catch on to these concerns as a child is growing in the early childhood years.
  • When deficiencies in motor skills are found in young children, we assess the child's fine motor development through the Ages & Stages Questionnaire (ASQ).
  • When detected later in the childhood years, we may set up an assessment with an occupational therapist who can help make a proper diagnosis and create a treatment plan.
• The home environment or family culture can sometimes be an obstacle for children to learn well. Bronson has medical social workers in our pediatric offices who help us assess obstacles your child may be dealing with, and come up with a plan to make learning better. These medical social workers can help in several ways, ranging from speaking with teachers and school principals, to setting up counseling for the child and/or family.
• Anxiety and depression can cause major distractions in a child’s mind, making it difficult for them to learn properly. These health concerns can stem from a wide range of situations - sometimes school, sometimes home and sometimes other factors. If we see a child who seems to be struggling with a mental health issue, we can facilitate meeting with a counselor or psychologist. At times, we will prescribe children medication in conjunction with counseling to help them feel better.
• Learning disabilities can show up in a subtle way, but most children start to struggle with learning disabilities when they get to about 2nd or 3rd grade. This is a time when children are going through major learning transitions in regards to reading and writing. In early grades (K-3) they are learning to read/write. In later grades (3rd and beyond) they are reading/writing to learn. This can present a major challenge for children with learning disabilities, and you will often notice a drop in grades. From the behavioral point of view, children may become anxious, defensive, argumentative and non-compliant. Let us know if you or your child's teachers has concerns with behavior and/or grades. Schools, through government aid, can set up Individualized Education Plans (IEP) or 504 plans (Civil Rights Law that provides accommodations and modifications in the classroom to improve learning for children).
• Some children have intellectual disabilities and may find learning a challenge. In contrast to learning disabilities where the problem is mainly academic, in intellectual disabilities there is a problem with intelligence (which can be measured with an IQ test) and with “adaptive behavior” (getting dressed, taking showers or brushing teeth, to name a few functions).
• Some children are on the autism spectrum (ASD). The diagnosis looks at communication, social skills, a child's ability to interact with other children, and mannerisms that are called stereotypes (repetition of physical movements, sounds, words or moving of objects in repeated sometimes rhythmic patterns).
• Attention Deficit Hyperactivity Disorder (ADHD) is a medical condition that makes it difficult for a child to focus properly. Some common symptoms include:
  • Inability to focus or lack of attention
  • Impulsivity (doing things without thinking or planning)
  • Hyperactivity

ADHD diagnosis calls for these problems to be present in at least two environments, such as home and school. In addition, the symptoms cannot be due to other psychiatric problems such as anxiety, depression or schizophrenia. ADHD can be tricky, however, because it is possible to have ADHD with an associated anxiety or depression problem. The evaluations with psychologists or medical social workers help us, as pediatricians, sort out these problems.

Other areas of possible concern include the concepts of Executive Function and Working Memory. Imagine a tower control at the airport managing airplanes that are using paths for taxiing, and runways for take offs and landing. In addition, the traffic controllers have to keep track of airplanes that are up in the sky at different altitudes as they approach the airport. We, too, handle multiple points of information on which we may make several decisions at a time. Some of these require that we prioritize and organize our thoughts. For some children, and for some of us as adults, this can be a challenge. There are techniques, resources and skills that can help us improve on executive function and working memory. We can address these with you and your child when you come into the office.

So what is the next step?

As we approach spring break and enter the last marking period of the school year, you might find yourself in a good position to reassess how your child has been doing in school, and whether there is a need to evaluate further if they did not perform as well as they could have.

If your child is having academic difficulties, we encourage you to make an appointment with your child’s pediatrician. Often, we can make a referral to a medical social worker or psychologist who can test for medical conditions like those mentioned above. If a concern is found that points to a possible learning disability or intellectual disability, your child can be set up with a referral to a neuropsychologist for further evaluation. If a medical condition is diagnosed, all health providers can work together with you and your child to create and carry out a care plan that will help your child achieve academic success moving forward!

References:

• AAP Publication Why is my child having trouble in school?
• Pediatric Education what causes school failure?