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School Failure in Children

School failure can lead to serious consequences if untreated. Figure 1 illustrates the vicious cycle to which learning problems of any cause can lead if not remediated appropriately. The failing student loses self-confidence, becomes discouraged, decreases effort, and fails further, continuing a downward spiral from which there seems to be no escape. If unchecked, the failing child eventually enters

Prevalence and Etiology of School Failure

Estimates of the number of children receiving some degree of specialized educational assistance range from 10% to 15% of the school-age population. Table 1 outlines the various etiologies and incidences of school failure. Some of the

Discussion of mental retardation is beyond the scope of this article. Of course, more severe retardation will have been diagnosed in infancy or the preschool years, but some of the milder forms of this disorder are not discovered until the student begins to have difficulties in the early grades. Psychological testing will indicate a

The precise definition of learning disability has been debated for years and still has not been accepted universally. A broad definition with which most agree is that the student of average or above average intelligence is not performing up to

Attention deficit disorder (ADD) has been a controversial subject since the term was coined more than 2 decades ago. Because ADD clearly is a significant cause of

Emotional disturbance as a cause of school failure is increasing, probably reflecting, among other factors, increasing stress among children due to family

Children who have a chronic illness are at risk for failing in school for several reasons. If the chronic illness entails neurologic dysfunction, such as in spina bifida, learning ability will be affected directly. Other causes of chronic illness may lead to school failure by increasing school absence during exacerbations of the condition. In these situations, it is the duty of the pediatrician to ensure optimal management of the illness so as to reduce school absences to an absolute minimum. This

The final category of ill-defined factors is problematic in that they are somewhat vague and elusive. The situation can be described best as a lack of "fit" between the personality characteristics of the student and the expectations of teachers and, on occasion, parents. In this situation, the child loses self-confidence, becomes discouraged, and loses motivation.

Pathogenesis of Learning Disability

The various causes of learning disability are listed in Table 2; often, more than one factor may be present. Hereditary factors account for a fairly large proportion of cases, but the pattern does not conform to mendelian rules. Early language dysfunction from any cause, including decreased hearing for prolonged periods during the first 2 to 3 years of life due to chronic serous otitis media (a possible etiology still

Children who have "central nervous system dysmaturity," as

Sociocultural deprivation is an increasing cause of learning disability, particularly in the "inner city" of larger metropolitan areas. These

The remaining four causes of learning disability involve insults to the central nervous system at various stages of its development. Toxins such as alcohol and other drugs ingested during pregnancy have been proven to lead to major deficits in higher order cognitive functions. Similarly, postnatal exposure to toxic substances such as lead can lead to specific learning deficiencies. Vascular accidents and anoxic episodes in the

Evaluation of the Child Who Has Failed in School

Evaluation of this child calls upon all of the skills of the pediatrician and requires a significant time commitment and follow-up. It is wise, therefore, to schedule sufficient blocks of time for the various aspects of the evaluation. Table 3 outlines the components of a complete assessment of the


At some point, school personnel will recommend program changes for the student designed to enhance his or her learning. These can be confusing and frightening to the family, and the pediatrician again can intervene to allay their fears.

Parents need to understand the term "least restrictive environment," as called for by federal law and as interpreted differently by each