Get Well Wednesday: Addressing School Underperformance in Schools

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    Adiaha I. A. Spinks-Franklin, MD is a Developmental-Behavioral Pediatrician in the Meyer Center for Developmental Pediatrics at Texas Children’s Hospital and Assistant Professor of Pediatrics for Baylor College of Medicine. Dr. Spinks-Franklin is Associate Fellowship Director for the Developmental-Behavioral Pediatric Fellowship at Texas Children’s Hospital/Baylor College of Medicine.

    In addition to evaluating children with developmental and behavioral concerns, her research interests investigate health disparities in children with autism spectrum disorders, the mental health impact of adoption on children, and the cultural aspects of child developmental, including how racial and ethnic identity development influence academic outcomes in children.

    Is the red dye in food a problem?
    Research has found that there is no association between red dye and learning or behavior problems in children.

    What do you do when your ADHD child says he doesn’t understand a problem and the teacher tells him that she doesn’t have time to stop the class to keep explaining things?
    Great question. Please speak with your child’s teacher; most teachers will respond to emails from parents. Meet with the teacher face-to-face if possible to discuss your concerns about your child’s math difficulties. If you are concerned your child has a learning disability, write a letter to the school asking them to test your child. Sign and date the letter and give it to the Special Education Director at your child’s school. Finally, find a private tutor to help your son with math homework, such as a retired school teacher. Many houses of worship have free tutoring programs for the community.

    My son has been under-performing, not doing work and doing homework but not turning it in. He’s shown a sign of a disability since kindergarten and I don’t know what else to do now that he is 17-years-old.
    Your son should be evaluated for a learning problem. Write a letter to the school asking them to test your son for a learning problem. Sign and date the letter and give it to the Special Education Director at your son’s school. You can also ask your son’s primary care doctor for a referral to a specialist such as a Developmental Pediatrician, Child Neurology, or Child Psychologist to have an evaluation to help determine why your son is struggling in school. You may also like to find a private tutor for him, such as a retired school teacher, who can help address his school struggles.

    How do I best address issues of a child doing well on all things except on state tests?
    Some children struggle with high stakes exams, such as state exams that are mandated by No Child Left Behind. Some children develop test anxiety because of the pressures they are under when taking those types of tests. Please work with your child’s teachers to find ways to help your child develop test-taking strategies, learn relaxation techniques (such as deep breathing, visualizing relaxing places, etc.) and use positive self-talk when taking tests. Remind your child that the test is not a measure of how smart or talented your child is.

    My son has been diagnosed with ADD and anxiety by two physicians. His father refused to accept the diagnosis along with any help, medication, or special ed. He also told my son nothing is wrong with him and he is just not trying. So my son refuses any help and continues to under perform. What should I do?
    ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are serious neurodevelopmental disabilities that are caused by differences in brain development. There are a number of brain chemicals that do not perform properly when a person has ADHD/ADD. Anxiety Disorders are found in about 25% of children, teens and adults with ADHD/ADD; anxiety is also a brain-based disorder that can affect the way a child performs in school and other activities. 70% of people with ADHD/ADD have learning problems in school. Research has found that if children with ADHD/ADD do not receive the type of help they need in school and medically, they are at a high risk of repeating a grade, dropping out of school, and getting involved in criminal activity. Children with ADHD/ADD need educational supports (for learning problems), behavior interventions (for organization skills, social skills, and learning self-control), and those with moderate to severe symptoms also need medication to address the biological aspects of the disorder.

    I need to know what can I do for my son, he has been an honor roll student until last year. He is now in the 9th grade and he is getting worse. I have tried talking to the teachers to work with them and they are trying to help but we are not getting anywhere. I am so frustrated!
    9th grade is a very challenging transition for children. Many students who performed well in school prior to high school begin to struggle when they transition to 9th grade. Your son may also feel frustrated with his own poor school performance. If teachers are not responding to your concerns, speak with your son’s guidance counselor and assistant principal about your concerns. Hire a private tutor for your son, such as a retired school teacher, to help him one-on-one with homework. If you address his problems in school early and aggressively, you may help prevent your son from being too discouraged. Also, find out whether or not your son is being bullied in school. School bullying peaks as children transition out of middle school. Children who are the targets of bullying tend to have poorer performance in school.

    My child is having problems with reading a story and  telling what it was about after. He’s great in everything thing else?
    Reading fluency (reading fast and accurately) and reading comprehension are common problems in children and are often most noticed when children start 4th grade, where reading comprehension is emphasized. Continue to read with your child daily, at least 20 minutes a day. Select books for your child, where s/he does not have to sound out more than 4 words on a page. If a child has to struggle to sound out more than 4 words on a page, that book is too difficult for her/im. Talk to your child’s teachers about your concerns with his/er reading skills and ask them to work with you to help your child. If talking to teachers is not effective, please write a letter to the school asking for them to evaluate your child for a reading or learning problem. Sign and date the letter and give it to the Special Education Director of your child’s school. This will start the process of getting your child formally evaluated. Finally, ask the school guidance counselor for a list of private tutors. A retired school teacher could be a helpful tutor for your child.

    Is there a natural alternative to Adderall? I  Want to see if there’s something else for a 15-year-old?
    Good question. There is no research to support herbal supplements to treat Attention Deficit Hyperactivity Disorders (ADHD). The medication that is used to treat ADHD specifically targets the biological aspect of the disorder, helping the Serotonin and Dopamine in the brain function the way they are supposed to. It is important that if your child takes medication that the medication is taken specifically as directed by the doctor. It is also important that your teen eats a balanced diet, does not skip breakfast, and gets adequate sleep. Sleep and nutrition are important for learning and good school performance. Remember that children and teens with ADHD also need educational supports and behavior interventions to help him function well in school. If you are concerned that medication is not working well for your child, please speak with the doctor that prescribed the medication for your child to discuss other options.

    Do you think a lot of the learning issues come from what they have to learn and it being fast tempo on today’s kids. I remember when I was in 2nd grade and I had to just really start learning how to spell and basic math, now they have to know how to read and go back to the big story and solve the word problems without any help. Also, they have to do things like write full length sentences about things, when they  don’t even know what some words mean.
    Learning expectations have increased over the years. If it seems that school work is being presented at a pace too fast for your child, please talk to your child’s teachers and ask them if they will help your child with homework before school or after school. Many teachers offer tutoring for students throughout the week. If you are concerned your child may have a learning disability, write a letter to the school asking for them to test your child for a learning disability. Sign and date the letter and give it to the Special Education Director of the child’s school; this will start the process of getting your child evaluated. Finally, please consider hiring a private tutor to help your child with homework, such as a retired school teacher. Many children benefit from having one-on-one tutoring. You can ask the school guidance counselor for a list of tutors.

    My son is not doing well in two subjects, he has a mild case of cerebral palsy. We are asking the teachers for help but they haven’t given any practice work and extra homework . What else can we do?
    Children with cerebral palsy are at increased risk of having learning problems. If your child has cerebral palsy, he may qualify for special education services under the category of Orthopedic Impairment or Other Health Impairment; these are federal special education categories where children are receive extra help in school. Please write a letter of the school stating your child’s diagnosis(es) and asking them to evaluate your child for learning problems. Sign and date the letter and give it to the school Special Education Director. This will start the process of getting your child evaluated for extra help in school. If your child has been evaluated by other specialists, take copies of the evaluation reports to the Special Education Director as well; this can help build a case for having the child evaluated in school. Finally, consider hiring a private tutor to help your child with homework, such as a retired school teacher.

    My child’s teacher says my daughter is having problems paying attention and keeping on task. He said she’s good in the morning but by the afternoon, she seems distracted and not focused on her work at all. Please advise.
    Many children who struggle to pay attention have more problems in the afternoons when their minds are more fatigued. There are many conditions that can lead to attention problems in children such as hearing problems, visual problems, learning disabilities, anxiety, depression, Attention Deficit Hyperactivity Disorder, inadequate sleep, anemia, psychosocial stressors, being bullied in school, and others. I suggest meeting with your child’s teacher face to face to discuss the concerns. Talk to your child about her difficulties paying attention in school and get her perspective. Finally, you can ask her doctor to evaluate her for possible medical conditions that can cause attention problems, like I listed above.

    My child is 4-years-old and he was diagnosed with aggressive defiant behavior. He has not started school as of yet. What type of school should I look for?  Would he automatically be put into a special ed class?  
    I suggest having your child evaluated by a Developmental Pediatrician to determine whether or not he has a developmental disability. Sometimes aggressive behaviors can be a sign that a child has an underlying developmental disability. Your child may also benefit from a type of behavior therapy called “Parent Training”; this type of behavior therapy is specifically designed to help parents who have children with aggressive behaviors and oppositional defiant behaviors. By federal law, public schools are supposed to provide support for children who have behavior disorders, and the school can evaluate your child by doing a Functional Behavior Assessment (FBA) to determine why your child’s behavior occur and how best to reduce aggressive behaviors. You may like to speak with your child’s primary care provider about private schools in your area that are designed for children with various behavior disorders or developmental disabilities.

    I had my child tested & the results came back that she did not have a  learning disability. However they continue to recommend medication because she is easily distracted. She has no behavior problems. I’ve never been called concerning discipline or her distracting class or being a nuisance. I am not against medication if she needs it, but I really don’t think she does. Her grades  are not failing, but certainly could be better. They are not where I want them to be. Would you recommend medication in a situation similar to mine?
    First you have to figure out why she is not paying attention. There are a number of reasons by children do not pay attention, such as hearing problems, poor vision, anemia, inadequate sleep, skipping breakfast, being bullied, anxiety, depression, Attention Deficit Hyperactivity Disorder (ADHD). Talk to your child’s primary care provider about evaluating her for possible causes of not paying attention. It is important to know what you are treating when giving your child medication; find the underlying cause first.

    My son is almost four and he has a short attention span.  Is there anything that I can start doing now to help him learn how to be still, concentrate and focus?
    This is very common. There is an association between the number of hours children spend in front of a screen (TV, computer, hand help video games, etc) and short attention span. The more time a child spends in front of a screen, the shorter the attention span. Children age 4 years old are only supposed to watch 1 hour or less of screens a day. The rest of the time should be spent in play, learning activities, and physical activity. Create a schedule for your child and provide more structure and order. Sometimes if the home environment is unstructured, this can be over-stimulating for some children.

    Tom, the doctor Is on point. I provide counseling services for children with mental health diagnosis. And every child we diagnosis, we have the parents request a 504 test through the school system. This test allows children more time on test that they take in the classroom. A little thing like more time on test has increased our children grades tremendously. What does the doctor think?
    A 504 Plan is an informal plan for accommodations for a child, such as extra time on tests, sitting near the teacher, and shortened assignments. However, a 504 Plan is not a legally binding document, nor is a 504 Plan adequate for children who have learning disabilities or other developmental disabilities. An Individual Education Plan (IEP) Is what is needed for children who have more significant learning needs.

    My daughter has an IEP and is scheduled to be retested in January. 3rd grade has been a challenge for both of us.  We live in MD, outside of the  DC metro, I want to find a good child psychologist to work with her as well. Do you have any you can recommend?
    Talk to your child’s primary care doctor for a referral to a child psychologist in your area. I do not know any specific providers in your area. Also check with your insurance company for a list of providers in your area that take your insurance. Also consider some of the major medical centers in your area such as Children’s National Medical Center and John’s Hopkins Kennedy Krieger Center; both medical centers have child psychologists and Developmental Pediatricians who can evaluate your child.

    My 7-year-old son was diagnosed with depression, ADHD, anxiety, and add. He’s on medication and has been on it (adderall) since his diagnosis.
    It is common for children with Attention Deficit Hyperactivity Disorder (ADHD) to have anxiety and depression; all of these are brain-based conditions that effect a child’s behavior and learning. In addition to medications, I suggest your child participate in play therapy with a child psychologist. Play therapy can help children learn coping strategies for managing their anxiety and depressive symptoms. Family therapy with a trained psychologist may also be in order to address the possible stressors your family has experienced that may affect your son.

    My child is 11 in 6th grade and goes in diagnosed with Aupergers and ADHD. He is a very funny, loving smart child. His favorite subject is math and is A student in the subjects of math and science, however he is weak in reading and language. His teachers say that he is very smart but he “avoids” doing his work on a daily basis, that when he’s angry he bolts or stays long periods of time in the bathroom. I don’t know what to do about this issue. I want him to succeed and to show his true ability. How or what can I do? Thank you.
    Good question. Many children with Asperger Syndrome have problems with reading comprehension. All children with Asperger Syndrome have language disorders that affect the social component of language. It is common for children with Asperger Syndrome to have ADHD, and many also have Anxiety Disorders. I suggest talking to your child’s teachers about ways of giving him extra help in school. He may be able to qualify for special education services under the categories of Autism and Other Health Impairment (OHI). Write a letter to the school listing your son’s diagnoses (Asperger Syndrome and ADHD) and ask them to test your son for learning problems. Sign, date the letter and give it to the Special Education Director. Most children with Asperger Syndrome need some educational supports in school.

    My son is a ninth grader who previously got decent grades but now is failing even in gym class what can I do to help my child ?
    9th grade is a challenging transition for many children. If he is failing all of his classes, this could be a sign that something serious is going on, such as depression, bullying, substance use, etc. Talk to your child to try and get an idea of what is going on with him in school. Meet with his teachers face-to-face to discuss your concerns. Also, you may want to ask your son’s primary care physician for a referral to a mental health provider, such as an Adolescent Psychologist, for counseling to get to the root of what is going on with your son.

    Does speech inconsistencies such as stuttering in children over 5 mean there is/will be a learning disability?
    When a child over 5 years old continues to stutter, they are more likely to have a stuttering disorder that will persist. Children with speech and language disorders, such as stuttering, are at increased risk of having learning disabilities. Therefore, if you are concerned, please write a letter to the school listing your child’s diagnosis (stuttering) and asking for an evaluation for speech problems and possible learning problems. Sign and date the letter and give it to the Special Education Director of the school; this will start the ball rolling in getting your child evaluated. Your child could qualify for special education services under the category of Speech and Language Impairment and receive speech therapy in school.

    I was listening to you this morning but I did not hear the answer to which specialist you should bring a child to for evaluation if you suspect a learning disability. Any place u can get the testing anonymously?
    Developmental Pediatricians are specialists who evaluate children with learning disabilities. You can also have your child evaluated by a child psychologist for psycho-educational testing.

    My nephew is in the 2nd grade and has these outbursts. He gets loud or sometimes he throws things. He doesn’t have these outburst with me but with others and people in school he does. He has been checked out and he doesn’t have ADHD. We have cut back on sugar. We also punish him for his actions. I’m not his primary caregiver, just a concerned aunt.
    I suggest asking the child’s primary care doctor for a referral to a Child Behavior Psychologist for behavior therapy and parent training. A well trained behavior psychologist can help the child’s parents develop effective parenting strategies and help the child learn better ways of controlling his angry feelings.

    What do you as a teacher who knows students have development issues but can’t say certain things to parents (legally) or the parent hen confronted with performance data the parent blames the teacher when their child needs help for large gaps. Especially as readers. This is especially the case in Economically disadvantaged communities where development delays are stigmatized.
    This is a good question. There are a number of teachers who have successfully advocated for children with learning deficits to be evaluated for by the special education committee in the school. You may consider speaking with the Special Education Director in the school about implementing some parent education workshops or activities to inform parents about learning disabilities and ways to help their children perform better in school. The school web site could be a helpful resource for learning materials for parents. Also, if your school does not properly implement the Response to Intervention (RtI) program, please talk to the Special Education Director about providing teachers with the appropriate training and resources to implement RtI, which can address a lot of learning problems in children without the special education process.

    I am struggling with my son in school. I do believe that he has a learning disability. He will be tested and evaluated in December. What can I do to help?
    I am so happy to hear your child will be tested soon. Good job advocating for your son! In the meantime, educate yourself about learning problems and learning disabilities. There are a number of web sites with helpful and accurate information such as LD On-line (www.ldonline.org) and Reading Rockets (www.readingrockets.com). Explain to your child that he will be evaluated to help figure out why he is struggling in school; let him know that learning problems are very common and he can receive the extra help he needs. Also consider hiring a private tutor for your son, such as a retired school teacher, who can work with him one-on-one once a week to help with homework or help teach him concepts that are challenging for him.

    What do you do if the parents and teachers have failed to help or diagnose the problem and now the child is 18.  He has dropped out of high school but has enrolled to get his GED.
    When a child is 18 years old and is no longer in the public school system, you will need to have him evaluated by a private psychologist who can perform a psycho-educational evaluation. A psycho-educational evaluation will include IQ testing, a speech and language evaluation, and academic testing. The psychologist can then give recommendations for occupational and educational interventions for your child. A number of community colleges also provide assistance for students who have learning problems. Finally, ask your child’s primary care doctor for a referral to a local psychologist for the testing; you can also check with your insurance company for a list of psychologist they cover.

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