You can help your patients "fit in" at school

Oct. 9-Atlanta

That first day of school: an exciting occasion for many children but, regrettably, a time of dread for some students. What’s the problem? The task challenge of making friends and trying to be popular-an important part of a child’s education but an experience that isn’t always an easy or successful one.

“Friends affect the quality of life the most,” said Barbara J. Howard, MD, co-director of the Center for Promotion of Child Development Through Primary Care in Baltimore, Md., during a presentation on behavior problems in school age children today at the AAP’s National Conference and Exhibition.

During late elementary-school years, children often talk about making friends and being popular; they are eager to be friendly, but not a pushover. Dr. Howard explained that school-age children fall into one of six categories: victim (shy, sensitive, and exhibiting passive behavior); bully (limited academic or social skills and possibly from a dysfunctional family); member of a clique; “left out,” often because of poor social skills or being victimized by discrimination; follower (giving into pressure to engage in substance or alcohol abuse or sexual activity); and under high pressure to perform well in school and in sports.

In cooperation with the efforts of parents, you can offer counsel to help your patients who have a difficult time fitting in or making friends at school (or both). Here’s how to set the stage for offering assistance:

• Listen to the child’s problem; ask what you can do to help. This gives the child more courage to solve the problem-or come up with a solution on his (or her) own.

• Be empathetic. Sharing a story of your own that relates to the situation that your patient is experiencing can be helpful.

• Have parents create a structured environment for their child. Have them set clear expectations and rules, and omit stressors. Peer groups often get more powerful as children enter adolescence, and it’s parents’ responsibility to protect their child. Building a framework of support can help.

• Recommend sources of support for the child. Tutors, homework buddies, and role-playing can be a valuable asset.  “Values clarification” helps when the problem is bullying and antisocial behavior. Often, it’s the bully-the child with the most aggression and the most anxiety-who is most likely to be socially isolated.

• Advocate removal from school-for part of the day or fully, for home schooling-for a child who is experiencing the most severe social difficulty.

“Ultimately, it is the child’s problem to solve,” Dr. Howard said. “You can’t fix these things.” She emphasized, however, that you can assist a child in overcoming his problems by building up his strengths; by providing positive role models and opportunities for self-expression; and by encouraging him to pursue interests outside the school day and the school peer group.