‫سورة البقرة‬
‫آية (‪)32‬‬
Neurobehavioral symptoms among sixth grade primary
school students with low scholastic achievement in
Assiut city
By
Saber .A .Abdelnazer
lecturer of Neurology,
Faculty of Medicine, Assiut University
Under supervision
DR .Hamdy .N .El –Tallway
Professor of Neurology, Faculty of Medicine, Assiut University.
Dr. Abdel Rakeeb .A .Elbehaery
Professor of psychology, Faculty of Education, Assiut university
Dr. Khaled .A .M .Elbeh
Professor of Psychiatry, Faculty of Medicine, Assiut University.
Dr. Noha .M .Aboelfetoh
Assistant Professor of Neurology, Faculty of Medicine, Assiut University.
2014
Introduction
Aim of the work
Subjects and methods
Results
Discussion
Conclusion and Recommendations
Introduction
Education is one of the main foundations for the
child’s development and national human resource
development, therefore failure at school and grade
retention is a serious concern among children and
their parents, as every child should have the
opportunity to achieve his or her academic potential
(Kamal and Bener , 2009).
Poor school performance should be seen as
symptoms reflecting underlying larger problem in
children. This symptoms not only result in the
child having low –self esteem but can cause
significant stress to the parents and it is essential
to analyze these symptoms to discover underling
disorders (Karande and Kulkarni , 2005).
Hypothesis
Education is an investment in human capital
and it can have great impact on nation’s growth
and progress. School failure can lead to serious
consequences if untreated; the failing student
losses
self-confidence
subsequently
becomes
discouraged and involved in self-harming behavior.
Sorry, Egypt was ranked the last in global
competitive report in quality of primary education,
although every Egyptian knows the low level of
primary
education
but
he
bumped
his
classification of the worst compared with rest of
developed, developing and under developed
countries (Global Competitive Report,2013).
Aim of the work
This study was designed and aimed to estimate
the prevalence of
neurobehavioral
symptoms
among children with poor scholastic achievement
compared to good achievers in the sixth grade
primary governmental schools in Assiut city.
This is a cross-sectional study conducted on students
of the 6th grade primary schools in Assiut city during period
from September 25th , 2011 to May 15th , 2013.
 All students in grade 6 of 38 governmental schools in Assiut
city were approached to identify students with poor academic
achievement .
 Poor scholastic achievement is defined here
as "students
failing their grades at least once and had to repeat the year or
those who had <70% of school marks in previous year”.
The
total
sample
size
was
4440
students
representing all students in sixth grade of 38 public
schools.After reviewing their medical health status,
1.7% students sample (77 students) were excluded .
The representative sample size for screening of low
scholastic achievement , was 98.3 % (4363 )students
sample.
At The present study, 1362 students were
approached for
screening of neurobehavioral
symptoms and were classified into 2 groups as;
1-Low achievers (762 students) who achieve <70% of
school marks in previous year.
2-Good achievers
(600 students) were randomly
selected) who achieve >70% of school marks in
previous year.
Ethics issues
Before interview, informed written consent was
obtained from authority figures at the Ministry of
Education as well as from each school principle and
parents of students according to the ethics
committee of Assiut University.
Both groups (1362 students) were subjected to the following:
 Screening for symptoms of neurological disorders by using a simple
standardized Arabic screening questionnaire which was designed
and validated specifically for screening most common neurological
disorders(El-Tallawy et al., 2010), followed by complete clinical
and neurological assessment for those who screened positive for
any of neurological disorders.
 Screening of behavioral disorders :by using child behavior checklist
CBCL (Youth self report and profile for ages ranged from 11 to18
years )(Achenbach, 1997).
 Assessment of intelligence quotient (IQ): by using validated
Arabic Version of Stanford Binet scale ,4th edition (Melika, 1998 ).
 Assessment of socioeconomic state :by application of
Socioeconomic Scale (Abdel -Twab ,2010).
 Assessment of reading skills: by using the Arabic validated
translated version of Schonell(1950),(translated by Saad –El
Din, 1998).
 Evaluation of neurological soft signs among those students of both
groups: by using Subscales of the Cambridge Neurological Inventory
(Chen et al., 1995)
According to the definition adopted here, the prevalence
of low scholastic achievement was 25.7 %( n=1120/4363)
among students at 6th grade primary school. ,1120 students
were identified (25.7%) with low scholastic achievement , out
of them only 762 students accepted participation in this
study,(as 203 students refused participation and 155 were
absentees during interview).
Figure (1): Sex distribution among studied groups
Frequency in percent(%)
70%
63,40%
**
Males
60,30%
Females
60%
50%
40%
36,60%
39,70%
30%
20%
10%
0%
Poor
achievers)
Good
achievers
Figure(2):Frequency of subject failure among poor academic
achievers
25
21.5
18.6
Percent %
20
15
14.0
13.9
11.5
10
8.1
3.8
5
2.4
3.3
2.2
0
Science
Arabic
English
Males
Females
Math
Geographyn
Table (1): Socioeconomic status among poor and good
academic achievers
Poor academic achievers
n=762
Good academic achievers
n=600
N
%
N
%
200***
26.2
40
6.7
270*
35.4
236
39.3
292
38.3
324
54.0
Low class
Moderate
class
High class
Table (2): Classification of IQ among poor and good academic achievers according to
Stanford Binet 4th edition
Poor academic achievers
Good academic achievers
n=762
n=600
n
%
n
%
6
0.8***
200
33.3
201
26.4**
350
58.4
507
66.5***
50
8.3
47
6.2%
0
0.0%
33
4.3
0
0
25-<50
2
0.3
0
0
0-<25
12
1.6
0
0
Normal or
average (90<110)
Dullness(80<90)
Borderline
(70- <80)
Low IQ
(mentally
retard)
50-<70
Table(3): pattern of reading skills among poor and good academic
achievers
Poor academic achievers
n=762
Schonell’s
test
Males
n(%)
Females
n(%)
483(63.4%) 279(36.6%)
Poor
Readers
Good
Readers
Total
n(%)
Good academic achievers
n=600
Males
Females
n(%)
n(%)
362(60.3% 238(39.7
)
%)
Total
n(%)
381(65.2%)** 203(34.8%) 584(76.6%) 72(12%) 57(9.5%) 129(21.5%)
***
102(57.3%)
76(42.7%) 178(23.4%) 290(48.3% 181(30.2) 471(78.5%)
)
Figure (3):Frequency of neurological disorders among studied groups:
Percent
Total prevalence of neurological disorders among poor academic
achievers was 25.1% while 13% among good academic achievers
16
14
12
10
8
6
4
2
0
14.0%
10.3%
7.2
3.0% 3.1%
0.3% 0.26%
0%
0.26 0% 0.13%0% 0.13% 0%
Table(4): Frequency of internalizing syndromes among poor and
good academic achievers.
Poor academic achievers
Good academic achievers
n=762
n=600
N
%
n
%
131
47
584
17.2***
6.2
76.6
22
39
539
3.7
6.5
89.8
137
42
583
18.0***
5.5
76.5
25
42
533
4.2
7
88.9
139
40
583
18.2***
5.2
20
35
545
3.3
5.8
90.8
Withdrawal
Abnormal
Borderline
Normal
Somatic
complaints
Abnormal
Borderline
Normal
Anx/Depressio
n
Abnormal
Borderline
Normal
76.0
Table(5): Frequency of externalizing syndromes among
poor and good academic achievers
Poor academic achievers
Good academic achievers
n=762
n=600
n
%
n
%
Abnormal
141
18.5***
28
4.7
Borderline
47
6.2
38
6.3
Normal
574
75.3
534
89
Abnormal
136
17.8***
21
3.5
Borderline
47
6.2
41
6.8
Normal
579
76.0
538
89.7
Delinquent
Behavior
Aggressive
Behavior
Table(6): Frequency of non internalizing and non externalizing syndromes among
poor and good academic achievers.
Poor academic
achievers n=762
N
%
Social problems
Abnormal
Borderline
Normal
Thought
problems
Abnormal
Borderline
Normal
Attention
problems
Abnormal
Borderline
Normal
Good academic achiever
n=600
n
%
133
42
587
17.5***
5.5
77.0
22
37
541
3.7
6.2
90.2
140
40
582
18.4***
5.2
76.4
21
36
543
3.5
6
90.5
134
43
585
17.6***
5.6
76.8
25
35
540
4.2
5.8
90
Table(7):Frequency of soft neurological signs abnormalities among poor and good
academic achievers.
Soft neurological signs
Poor academic
Good academic achievers
achievers
n=600
n=762
Speech
66(8.7%)
21(3.5%)
Eye Movement
144(18.9%)***
14(2.3%)
Cranial Nerves
134(17.6%)***
52(8.7%)
Extremities Examination
327(42.9%)***
89(14.8%)
67(8.8%)**
9(1.5%)
Coordination
290(38.1%)***
123(20.5%)
Disinhibition
75(9.8%)
31(5.2%)
175(22.9%)***
42(7%)
44(5.8%)
13(2.2%)
Primitive Reflexes
Sensory Integration
Posture and Movement
Discussion
The present study identified
that 25.7% of students
(n=1120/4363) had scholastic backwardness .Boys are more
represented in both studied groups whether the poor
achievers or those with good academic achievement .This
might reflect more concern of parents with male than female
education ,at least in our studied community (Upper Egypt).
Our present study recorded higher rate of low
scholastic achievement among males than female it is
consistent with recorded data in Qatar (Kamal and Bener
study ,2009) and India (Karande and Kulkarni ,2005).
However , our recorded prevalence was higher than that
recorded in Qatar(4.7%) and India (20%) and lower than
that recorded in Mumbai(59.4% )( Vinod et al .,2013) .
The discrepancy in the rate of poor scholastic achievement
in different studies could be attributed to many factors .
1- The adopted definition of poor achievers in different studies
2- Variation in socioeconomic status of the studied samples
3-The number of students per class in
different studied
communities( over crowded classes as recorded in our present
study ) which approved by Nelson and Soli (2000) who
reported that overcrowded classrooms are often noisy and
distracting environment.
Concerning socioeconomic state, the present study stated
that the majority of students with low scholastic achievement
had low to moderate socioeconomic status which might
negatively
affect academic achievement compared to
students with good scholastic achievement. These results are
in agreement with recorded data in Iran( Azhar et al .,2013)
and USA( Topor et al .,2010 ).
.
Low socioeconomic state is expected to have negative
effect on school performance as it affects quality of life of
children and offers overload on their parents who give more
priority for housing, food and other basic life requirements
The present study reported that 76.6% of
students with poor school performance had reading
difficulties, with significantly higher rate among
males than females. This is in agreement with
recorded rate of reading difficulties
(76.2%) in
Mumbai study among students with low scholastic
performance (Vinod et al.,2013) while lower than
that recorded in Qatar (37.9%) (Kamal and Bener
,2009)
The higher prevalence of reading difficulties in
our study compared to other results was attributed
to different methodology, where reading difficulties
in our study was screened by Schonell’s test which,
roughly estimates reading skills regardless to I.Q
level of interviewed students.
The present study
reported that
26.4% of
students with low scholastic achievement
had
mental dullness and 66.5% of them had borderline
intelligence while 0.8% of children had normal
I.Q. At the same time , it reported that 66.6% of
control group had either mental dullness (58.4%)
and borderline intelligence (8.3%).
Despite this lower I.Q than normal(I.Q<90) among
control group ,they could attain good achievement.
According to the assumption that those students are
potentially educable inspite of their low I.Q score,
they could succeed in attaining normal achievement
level but if they combined with other factors such as
low
socioeconomic
classrooms,
status
and
overcrowded
they will fail in attaining normal
achievement levels as recorded in our study .
The present study reported that students with
low scholastic achievement had significantly higher
rate (25.1%)of neurological disorders than students
with good scholastic achievement (13.7%).
The order of frequency of neurological disorders
reported in the present study was headache
(14%),nocturnal enuresis (7.2%)and epilepsy (3.1%) .
In contrast to order of frequency of neurological
disorders
in
Epilepsy(25.9%)
Eritrea,
where
recorded
cerebral palsy (19.3%) , speech
and language problem (10.9%) mental retardation
(6.3%), movement disorders (1.4)and migraine 1%.
(Ogbe et al.,2005)
Concerning screening of behavioral problems, students with
low scholastic achievement had higher score than students
with good scholastic achievement on all child behavioral
checklist problem scales which include internalizing
syndromes (withdrawal, inattention/depression and somatic
complaints) externalizing syndromes (aggressive behavior
and delinquency) and social problems. Also, the present
study
reported
that
students
with
poor
scholastic
achievement had lower competence scales than students with
good scholastic achievement
These findings are consistent with recorded data in Brazil
where it reported a significant increase in child behavioral
checklist total problems among students with poor school
performance (Petresco et al ., 2014).
Also ,it is consistent with data of the previous study done
by Elbeh et al (2001) in Assiut
who
found
significant
negative correlation between scholastic achievement and
child behavioral
checklist total problems with higher
externalizing syndromes
and lower competence scale in
students with poor scholastic achievement than controls.
The present study reported that significant difference
in soft neurological signs (either in frequency or mean
score ±SD) among students with low scholastic
achievement compared to soft neurological signs
findings
among
student
with
good
scholastic
achievement).This is in agreement with recorded data
in U.K which reported that students with high scores of
soft neurological signs, were significantly performed
worse compared to good acdemic achiever (Fellick et al
.,2001).
Conclusion
The present study
reported high prevalence of poor
school performance among students in sixth grade of
primary school in Assiut city (25.7%),it reported that 25.1 %
of them had neurological disorders and higher prevalence
of behavioral abnormities among poor academic achievers
compared to good academic achievers with high rate of
reading disabilities and low IQ score(<90 among the first
group (76.6% & 99.2%) respectively.
Recommendations
 Based on the findings of the present study,
we
can
propose
recommendations:
the
following
 1- Encouragement of the prevalence surveys of neurological
disorders and behavioral problems in schools at different levels
among students for measuring the different rates of psychiatric
and neurological disorders.
 2- Establishment of strict recording system including data
gathering and statistical analysis regarding the neurological and
behavior problems at schools together with communication
between the schools at different levels of authority about this
problem.
 3- Strict filtering of students at start of primary and preparatory
school.