School Problems and the Family physician - Part I

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School Attendance Problems

School problems and the Family Physician

Dr. Latha Ravichandran, DCH, DNB(Pediatric Medicine)


School attendance, regardless of school performance is the best predictor of mental health in adulthood. School attendance is also an indicator of the well being of the child, the lack of which warrants the need to explore the causes. The causes of poor school attendance may vary from genuine Physical ailment, to behavioral problems to psychosocial problems at school or at home.
The Role of the Family Physician is to identify chronic illness or disorder contributing to poor school attendance and to treat any medical conditions.

Approach to a child with school attendance problems

Asst. Professor - Pediatrics
Sri Ramachandra Medical College &
Research Institute (Deemed University)
A. History
: Obtain a complete history, including symptoms related to any illnesses. Note psychogenic complaints, the parents method of managing attendance issues, behavioral problems at school or at home, and drug or alcohol abuse
B. Physical Examination: Perform a complete Physical Examination and Neurological examination. Identify any chronic illness or disorder contributing to poor school attendance (Asthma, severe acne etc), and treat any medical condition.
C. School Report: Find out about intelligence, achievement, school performance and grades, educational history, signs of stress or school problems, and changes in behavior at school
D. Assess Hearing and Vision: Consider this step, especially if behavior problem involves resistance about doing schoolwork.
E. Assessment of Family contribution: The Familyís contribution, particularly the motherís, is a crucial determinant of the type of the problem. Determine whether the mother encourages the child to go to school, monitors the attendance, and remains in touch with the school. Find out if she is allowing the child to stay at home with minor complaints, having a hard time letting the child go off to school, and/or transferring her anxiety to the child. Some parents actively discourage attendance because of distrust or disagreement, while some make no effort to send their child to school because of neglect.
F. When the family appears to encourage attendance yet the child attends irregularly, consider poor supervision and avoidance syndromes as the most likely reasons. Separation anxiety may be an important part of the problem.
G. School Avoidance: The term is used here to identify attendance associated with stress from difficulty at school. The stress may be caused by painful or humiliating experiences in the classroom, poor performance, panic attacks, or influence of th e older siblings or peers.
H. Avoidance Syndromes: These usually represent some form of agoraphobia and /or personality characteristics of withdrawal. Acute onset of school attendance problems in adolescence with a significant component of separation anxiety may be an early sign of psychosis.
I. Poor Supervision: Parents may encourage attendance but fail to supervise whether the child arrives at school. Truancy and involvement with the gangs, drugs and delinquency are often associated with poor supervision, lack of positive involvement with the child, and the discipline that is too lax or too harsh.
J. Separation anxiety: This may arise in a family, which encourages school attendance. This surfaces as a control issue, as when a young boy objects to his mother going for work when he is at school.
K. Folie a deux: Here there is very little differentiation between mother and the child, and the childís symptoms mirror those of the mother. A very disruptive form of this disorder is when the motherís anxiety is transferred on to the child interfering with his school attendance and performance.
L. Vulnerable child syndrome: The family may treat children with chronic illnesses (e.g. Pulmonary, Cardiac) unnecessarily as vulnerable. The family usually under estimates their capabilities. A team that can offer an integrated and coordinated approach to the child and the family best handles this situation..
M. School Phobia: This is based on separation anxiety and is commonly manifested by psychogenic symptoms (e.g. stomachaches, headaches) that appear only on the school days and strike a ready response in the parent who is not interested in separating from the child. All that is required is that the parents should insist on school attendance unless the physician specifies other wise. More severe problems not responding to this need psychiatric assessment.
a. School attendance is an important indicator of the physical, social and psychological wellbeing of a child.
b. The role of Family Physician is to identify chronic illness or disorder contributing to poor school attendance and to treat medical conditions.

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