For Children Who Struggle in School, An Approach that Works

For Children Who Struggle in School, An Approach that Works

The world of children who struggle in school is vast and deep. Fifteen million children, 1 in 6, experience academic defeat and its accompanying feeling of discouragement.   This means nearly every family has a child very unhappy in school, or knows of a family where a child is quite miserable from school.

Making families life so difficult is the unfortunate fact that these problems can have many, many causes.  It really does not take much for a situation to develop in which school work turns very difficult, unpleasant, discouraging.

Children can end up struggling in school if they have a problem with how their mind learns such as dyslexia, or with how they experience emotions as in depression or anxiety, or with how their teacher or family relates to the child, or if the child’s body has a physical problem such as poor hearing or vision, or if they are unable to focus attention.  Making life even more difficult is the very deep truth that many children can have a number of these possibilities each active at the same time.

As with any other problem, if the cause or causes of the difficulty are not clearly and accurately  found, one can spend a lot of time and effort putting into place therapies and interventions that simply will not work.   The better one knows the cause of a situation, the more likely plans can be crafted that will put the struggling student back on their feet.

Every year, millions of children in this country are identified for evaluation and intervention. This usually happens within schools, and any collaboration with pediatric physicians and other mental health providers occurs by written documents. The parents are required to “case manage” the child’s situation by transferring information among the parties. However, and far too often, when schools make contact with a child’s physician, the aim is to obtain medical management based on medication and not to obtain the wider, cross-disciplinary insights that can and should come from the pediatrician’s office.

How is the Advanced Pediatrics Approach Different?

In the current practice environment within our region, this case approach is unusual for two key reasons. First, there are fewer independent pediatric clinics with the required flexibility. This approach operates as a community-based model

which facilitates collaboration across disciplines to inform evaluation and intervention. Children from the same family may be subject for study within this team, recognizing that whole family dynamics can impact school function. Second, most institutions, including hospitals, medical centers, and even school systems, have separate departments for each of these disciplines, making the brainstorm sessions that are the essence of this approach cumbersome within their settings. In contrast to a “silo” process in which each discipline adds their perspective independently, this model generates information through vigorous discussion with representation of multiple disciplines.

The team assesses children either on the basis of history and information available or through a more intensive and direct evaluations. In the case of a direct evaluation, Dr. Lavin reviews the record, interviews the child and parents, and reads the available records together with the presenting problems. Dr. Weitman also reviews the records, interviews the child and parents, then evaluates the child as necessary, including cognitive/executive abilities, scholastic readiness and achievement skills, emotional features, and psychosocial situation. Ms. Lavin has full access to these results and acts as a consultant, often evaluating the child’s scholastic/problem-solving learning style. Once the record review and evaluations are complete, the team meets to consider the need for further information and the implications for intervention. The parents become part of the team at this point, and a division of labor is created to decide who will communicate with the school or with other providers who may be necessary for other diagnostic procedures or therapies.

Members of the team also provide medical guidance, counseling, cognitive training/rehabilitation, and other specialized interventions as necessary in order to improve cognitive/executive skills (e.g. working memory), scholastic skills, and/or family relationships. As a practical matter, schools often initiate these discussions with an implied request for medication to improve the child’s learning and/or behavior. However, since this team recognizes the risks, advantages and limitations of medication, we consider use of medication only after we have developed a coherent, valid, multi-factored understanding of the reason(s) why the child is struggling.

Roots of the Advanced Pediatrics Approach to Helping Children Who Struggle in School

This team’s approach has evolved from a rich university history within pediatric medicine, psychology, and special education, e.g. the Yale Clinic of Child Development, in whose precincts were launched the historically great study of children (1940) from age 0 to 16. The Yale Clinic under the aegis of pediatrician Arnold Gesell may have been the first modern example of a cross-discipline project whose purpose was to understand children medically/psychologically/developmentally, and to promote both developmental advice and useful intervention. More recently, and more local to this current project, The CWRU Child Mental Development Center evolved (1958) from a cross-disciplinary partnership in Cleveland between University Hospitals of Cleveland and Western Reserve University under the leadership of psychologist Dr. Jane Kessler and pediatricians Dr. John Kennell and Dr. Robert Bilenker.

Bottom Lines:

  1. So many of our children struggle in school.   It is a source of real suffering for both the children and their parents, and it is common.  At least 1 in 6 children struggle enough to experience real troubles.
  2. The key to helping children in this situation is to have a very real understanding of what is driving the difficulty.   Without this, plans and interventions can be proposed, but they are not so likely to succeed.
  3. An understanding of what is causing a child to struggle usually requires a look at a range of possible reasons, despite the temptation being very great to get to an answer very quickly and very simply.
  4. Advanced Pediatrics is very pleased that their approach to finding a path to understanding what really underlies each child’s troubles in school was recognized by the Society for Pediatric Psychology as a laudable approach to this challenge.
  5. Integrating and effectively channeling attention and resources to determine the range of causes for each child’s troubles in order to establish a foundation for years of effective therapeutic outcomes.
  6. Advanced Pediatrics is pleased to offer this approach to the children of the practice.

Advanced Pediatrics Receives National Recognition For This Approach

Across the country, the Society for Pediatric Psychologists, a section of the American Psychology Association, serves as the professional society for pediatric psychologists.  The SPP publishes a national newsletter and recently the Advanced Pediatrics approach to caring for children who struggle in school was featured.

The approach featured in the SPP newsletter takes the form of a diagnostic case conference. The pediatrician (Arthur Lavin, MD) collaborates with a clinical psychologist/neuropsychologist (Carl U. Weitman, PhD.), and an experienced teacher (Diane Lavin, M.S.Ed.) whose background includes creative and special education. Children evaluated and reviewed are typically from within the pediatric practice, but any member of the team can bring a case for review, consistent with privacy protection practices.

This case approach collates medical, social and educational history with current psychometric test results generated within the team or obtained from other providers including the school system.  Parents are often invited, sometimes with their children, to meet with the team and other providers, e.g. psychiatrists. The goal is to establish a cross-disciplinary diagnosis and to formulate interventions which, include referrals to other specialists and recommendations to the relevant school (accommodation) teams.

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