2019-20 TOW #9: School Readiness & Challenges

As pediatricians, we have a special role in helping promote and assess school readiness and addressing issues when challenges occur. We hope everyone has a great school experience, yet the literature tells us ~1 in 6 children experience school challenges or failure. (I prefer using the term “challenges” as it conveys more of a growth mindset; “school failure” is used in the literature on this topic, usually to signify failing a grade). Hopefully we can recognize and address issues early on through regular visits and monitoring in the medical home.

Materials for this week:

Take-home points:

  1. What is meant by “school readiness”? As written in the article above by the AAP Councils on Early Childhood and School Health, “school readiness includes not only the early academic skills of children but also their physical health, language skills, social and emotional development, motivation to learn, creativity, and general knowledge.” We have a lot of domains to consider when evaluating children’s readiness for school! In essence, it’s a very holistic approach to recognizing the broad influences on participation and performance in school, much more than knowing the alphabet and how to count to 10.
  2. How we can promote school readiness? In the medical home, we will naturally assess and address physical health needs. Beyond that, we can promote social-emotional health through nurturing strong, connected relationships (see last week’s topic on Promoting First Relationships). We can help families promote early cognitive growth by discussing early brain development and how families support this through reading (using Reach Out and Read), interacting, and enrolling in early learning programs like Head Start. We can also identify children with developmental delays and learning difficulties at an early stage by using appropriate screening tools.
  3. Epidemiology of school challenges: About 10% to 15% of school-age children repeat or fail a grade in school. Grade failure is more likely among males, minorities, children living in poverty, and those in single-parent homes. Children who have disabilities are nearly 3x as likely to repeat at least one grade as are children without disabilities. Similarly, children who were small for gestational age (SGA) are nearly 2x as likely to experience school failure. Children who fail in school are more likely to engage in subsequent health-impairing behaviors as adolescents. Failing students also are more likely to drop out of school and have adverse adult health outcomes.
  4. Differential diagnosis for school difficulties: Possible causes of school challenges should include evaluating exogenous and endogenous factors. Exogenous factors include stressors in the home, poverty, and negative peer influence or school environment. Endogenous factors include learning disabilities, ADHD, chronic illness, perinatal conditions (e.g., prematurity, fetal exposures) and mental health disorders.
  5. How can we help families facing school difficulties? Clinicians can help families identify the causes of school challenges and advocate for resources to improve a child’s academic trajectory. It can be very important for a child’s doctor to get involved with a child’s school to ask questions, discuss resources, and advocate for services. The law protects students’ rights to have their educational needs addressed through the Individuals with Disabilities Education Act (IDEA). Under IDEA, schools must identify children with disabilities, evaluate their needs, provide services, and guarantee due process, including the provision of Individual Education Plans, or IEPs. We can utilize the resources of school family advocates, omsbudsman, counselors, social workers, and medical-legal partners to advocate for children and their access to services.

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