Helping academic underachievers become achievers in their own right

Helping children achieve their potential is a central role for the pediatrician. In this article, which is based on evaluations of children who were referred to the Riley Hospital Behavioral and Developmental Clinic (Indianapolis) because of academic underachievement, we move the topic of school failure out of the subspecialty referral environment to review your generative role in preventing and remediating academic underachievement. The topic may feel unfamiliar because it appears infrequently in pediatric journals and continuing medical education programs, but discussion of this prevalent problem certainly is common in the literature of education and psychology.

Generativity, first described by psychologist Erik Erikson, is the stage of psychosocial development that is characteristic of middle adulthood. It is exemplified by the teaching and caring role of physicians, teachers, scientists, mentors, coaches, tutors, counselors, and others who contribute to the health, development, and achievement of children and adolescents, as well as to the self-efficacy of parents. Generativity is an especially appropriate role for the pediatrician because of the opportunities you have to counsel parents and children within a continuing, trusting relationship.

We recognize that the primary care pediatrician does not usually have time during regularly scheduled office visits to utilize, in their entirety, the therapeutic approaches that we recommend here. But these approaches can be adapted to time available or accomplished in collaboration with a behavioral-developmental pediatrician or clinical child psychologist. This review underscores the importance of identifying children at risk of academic underachievement, especially in the preschool years, and of discussing preventive measures during health supervision visits.

In addition to initiating a therapeutic relationship and providing historical information, the interviews permitted observation of parents and child and their interactions, which was helpful diagnostically. Initially, the "databases" that the physician, parents, and child bring to such interviews are asymmetric; that is, the physician is much better informed about the causes of academic underachievement, and the parents and child are more familiar with their personal family histories and relationships. An important goal of the interviews is to blend these complementary sets of data into a shared comprehension of what is causing the underachievement and what strategies are required for remediation.

One-on-one interviews with the child provided such diagnostic information as how he (or she) viewed the presenting complaint. Importantly, the interviews also fostered the child's psychological identification with the pediatrician as an experienced, empathetic, and respected physician who has expert knowledge of what is best for the child's health and development. In addition to providing the child with a mental model for health and developmental practices, such identification imparts the feeling of being understood and regarded positively by an admired person-a subjective response that some children had not experienced often. Achievement of such identification, which is a powerful pediatric psychotherapeutic tool, was a major therapeutic goal with these children.