November 6, 2019

Pediatricians should treat bad grades like any other complex problem, AAP says

Daily Briefing

    The American Academy of Pediatricians (AAP) recently issued a report recommending pediatricians help "school-aged children who are not progressing academically," saying poor academic performance should be addressed like other complex pediatric problems, Peri Klass, a pediatrician, writes for the New York Times.

    Motivational Interviewing 101: Help patients take an active role in their care

    According to Arthur Lavin, one of the lead authors of the report, AAP aims to establish a standard of care for children who are not doing well in school. The report's suggested guidelines are not for students who are "doing OK" in school, "but perhaps not getting the straight A's parents might like," Klass explains—the guidelines are to help students who are "clearly struggling just to stay afloat."

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    Today, about one in six students meet that description, according to Lavin. He noted that "about one in six children are struggling in school to the point where they're really suffering, really feel like they're failing—and a lot of them are failing."

    Why AAP wants pediatricians to 'treat' poor school performance

    According to Laura McGuinn, professor of pediatrics at the University of Alabama at Birmingham and a co-author of the report, "Children not proceeding academically are usually not lazy. There's usually a problem underneath it, and it's usually a complex problem—all children pretty much want to succeed."

    Sometimes, these problems could be the result of a teacher mismatch, a poor social situation, or learning disabilities coming to light as a student's academic workload intensifies, Klass writes. For example, McGuinn said in younger children, academic issues could stem from a hearing problem that was missed early on or an intellectual disability. For older children, there could be bullying problems or emotional disorders such as depression or anxiety.

    To figure out why a child is doing poorly in school, Klass writes that a pediatrician needs to "loo[k] carefully at the child, liste[n] carefully to the story, and often [go] past the first easy solution."

    Separately, Lavin said, "It's a complex set of causes, like many things in medicine. It doesn't help children for anyone to come to them with the idea that a quick conversation or a simple test is going to give answers for the majority of kids."

    What AAP recommends pediatricians do

    The guidelines aim to help pediatricians work through that potentially "complex set of causes" to help the child succeed.

    To help pediatricians treat these children and improve their school performance, AAP in its report offers nine recommendations:

    1. Pediatricians should play "an active role" in preventing, diagnosing, and treating problems related to academic performance.
    2. Pediatricians should coordinate care for academically struggling students in the context of the child's medical home.
    3. Payers should consider covering all activities related to children who struggle academically.
    4. Pediatricians should understand that children in the United States have a right "to receive a free and appropriate public education"—including patients with learning and developmental disabilities, as well as those with chronic health problems—so that they can "effectively support families as they advocate for evaluations and interventions in the public school."
    5. Pediatricians should familiarize themselves with AAP's clinical report on the Individuals With Disabilities Education (IDEA) Act for children with special education needs.
    6. When determining how to approach evaluating a child, pediatricians should consider the depth and complexity of evaluation needed, as well as the costs to families and the level of insurance coverage needed for the evaluations.
    7. Pediatricians should collaborate with colleagues who can conduct further evaluations of children struggling academically, including subspecialists and school nurses.
    8. Pediatricians should understand the different goals of evaluations so they can direct to families to the most appropriate resources.
    9. Pediatricians should take "an active role in the initiation, development, and implementation" of Individualized Education Programs and plans under Section 504 of the Rehabilitation Act of 1973 when necessary.

    According to Klass, the guidelines do not mean that medical issues are the source of children's challenges, though they can be. Rather, she explains, "[I]t's often said that a child's job is to learn, and when something gets in the way of the child successfully doing that job, the child will often feel discouraged, unhappy and progressively disaffected."

    Without attention to this issue, McGuinn said, "We're leaving a huge sector of our population behind." She continued, "[Children who are struggling are] told so many times how awful they are because the school measures them compared to kids who, neurologically, do it easily, and it destroys lives every day" (Klass, "Well," New York Times, 10/7; Rey-Casserly et. al., Pediatrics, October 2019).

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