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”
“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
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
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)
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)
Sunil Karande
Below average intelligence
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Intelligence (measured as 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
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
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
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
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
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
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
Sunil Karande
Tourette syndrome
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Starts with ADHD
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2.4 years later develop motor and vocal tics
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Have learning problems: SpLD, ADHD, ODD, CD
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
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)
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
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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Lead exposure
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
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
Sunil Karande
Treatment
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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”)
Sunil Karande
Treatment of SpLD
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Remedial Education to begin during primary schooling
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Hourly one to one sessions thrice weekly for few years
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Systematic and highly structured training exercises
a) to learn that words can be segmented into smaller units of sound
“phoneme awareness”, and that these sounds are linked with
specific letters and letter patterns “phonics”
b) Practice in reading stories; both to apply newly acquired decoding
skills to reading words in context and to experience reading for
meaning
Sunil Karande
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Management of SpLD in secondary school is based
more on providing provisions / accommodations rather
than remediation:

exemption from spelling mistakes

availing extra time for written tests
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dropping a second language for work experience

dropping algebra and geometry for lower grade of mathematics &
work experience
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
Sunil Karande
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Children with TS need psychiatric medications for their
verbal/motor tics and co-morbidities
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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”
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
Sunil Karande
Thank You
Sunil Karande