When children are struggling in school, the first step is typically to talk to their teachers. Pediatricians can and should play a role in the discussion, too, according to a recent report from the American Academy of Pediatrics (AAP).
“This new policy paper from the AAP establishes the expectation that children who struggle to succeed in school present a problem that deserve the same level of attention as any other serious symptom requires, and that the pediatricians of the country are in a very important position to make sure this problem does get the attention each child deserves,” says Arthur Lavin, MD, a pediatrician at University Hospitals in Cleveland, Ohio, lead author of the report, and chair of the AAP Committee on Psychosocial Aspects of Child and Family Health.
Academic problems affect many school-aged children Lavin says, and the AAP report reveals that these problems may be independent of or occur in tandem to an underlying medical problem. Early recognition and intervention is key, and it’s an issue pediatricians should be asking about, Lavin says.
“As with any other symptom, the pediatrician can determine the actual cause or causes of the child's difficulties in school and approaches to helping the child turn struggle into success. This typically requires the help of other professionals, much as the evaluation and treatment of other complex symptoms often does,” Lavin says.
The AAP report recommends that pediatricians take an active role in the prevention, early identification, diagnosis, and treatment of academic problems. These steps involve care coordination, both with other medical professionals and with school partners.
“The school is always an important partner, at the very least it is the site of so many important observations, but beyond it will be at the school that plans are implemented, and where educational and psychological professionals are present for the child,” Lavin says. “For many, many children, the diagnostic process requires a collaboration with a psychologist adept at evaluations of complex presentations, often a neuropsychologist.”
Working with clinical partners is particularly important with academic struggles related to mental health, Lavin adds.
“Diagnosing causes for mental health challenges, such as struggling academically, is often very different from diagnosing physical health challenges in one important way. Often finding one explanation for a physical complaint can settle the question, eliminating other causes,” Lavin explains. “Consider a child presenting with a fever, and on exam you find evidence for an ear infection. We examine lungs and throat, but typically once you find a source of a fever, the problem is fully described. Not so typical for mental health issues.”
When mental health issues are present, they tend to be mutually inclusive rather than exclusive, he says.
“Many children may have a cognitive problem, such as dyslexia, and anxiety. And so the paper makes the point that pediatricians should be careful not to describe what may be a complex situation with the first diagnosis that seems to contain many of the child's symptoms in its definition,” Lavin says. “The key is to be able to ascertain which cause or causes for trouble in school are primarily driving this child's troubles.”
The report also suggests that pediatricians work with schools to take an active role in the initiation, development, and implementation of Individualized Education Plans and 504 plans when needed.
In developing the guidance, Lavin says he was surprised at how tremendous the need is for additional academic support among school-aged children.
“One in 6 children in the nation struggle to succeed in school, and the reasons they do number in the dozens. Failure to accurately find the causes leaves children and their family to suffer until the actual causes and effective therapies are found and put into place,” Lavin says. “Ongoing failure is severely painful to children and families often leading to an expanding range of mental health problems.”
Lavin says he hopes the report will inspire pediatricians to take an active role in the academic success of their patients.
“Our children do rely on their pediatricians to help them. It will only be by a thoughtful process of considering actual causes, the process of differential diagnosis, that effective interventions can be designed and succeed,” he says. “We have seen many, many children respond to a good diagnostic and therapeutic process. Helping a child go from failure to success is the heart of pediatric practice.”