School Problems in Children & Adolescents Patricia McGuire, M.D. September 16, 2006

Goals/Objectives: At the end of this conference, the participants will be able to:  Identify role of family physician in dealing with common school related problems with children and adolescents.  Understand need for systems based approaches for school issues  Identify the differences between diagnosis focused treatments and skills focused treatments.  Recognize opportunities for teaching parental advocacy.

Scope of School Problems  Learning Disability 5-10%  Mental Retardation 2-3%  Emotional disorders 10-20%  ADHD 3-5%

TOP SCHOOL RELATED CONCERNS?

TOP SCHOOL RELATED CONCERNS:  Gets poor grades  Doesn’t pay attention  Doesn’t seem motivated  Disrespectful  Doesn’t get along with peers  Seems sad, withdrawn, anxious  Gets sick a lot  Has poor attendance

Role of Family Physician Traditional Model Enhanced Model

Role of Family Physician  Traditional model Identifying physical problems that interfere with school functioning Utilizing diagnosis driven approach  Enhanced model Utilizing systems-based and skills- focused approaches to school problems Teaching parental advocacy in dealing with school systems

School Problems Diagnosis driven approach Symptom Diagnosis Treatment

School Problems Child FamilySchoolCommunityPeers SYSTEMS APPROACH

CHILD PARENT Family Physician School Nurse School Psychologist Principal Special Educator Guidance Counselor Teacher Multi-disciplinary Team

Medical Evaluation  Hearing  Vision  Growth parameters  Developmental status  Chronic illness diabetes, asthma, anemia, seizures, lead intoxication, otitis media,…

What Makes a Successful Student?

SKILLS!!!

Skill Pathways Child Cognitive ability Executive functioning Language processing Flexibility Emotion regulation Social skills Physical abilities

SKILLS PATHWAYS  Executive Skills  Language Processing Skills  Emotion Regulation Skills  Cognitive Flexibility Skills  Social Skills

Executive Skills  Shifting cognitive set – shifting gears from one thing to another  Organization & planning  Separation of affect – put feeling on the shelf and do thinking  Working memory

Language Processing Skills  Labeling / characterizing emotions  Communicating feelings / needs to others  Sorting through and selecting means to respond  Receiving feedback about one’s actions

Emotion Regulation Skills  Mood regulation outside the context of frustration: chronic underlying depression, irritability, anxiety

Cognitive Flexibility Skills  Flexible thinking vs. concrete, rigid thinking  Shades of gray vs. Black and white thinking

Social Skills  Recognition of impact of one’s behavior on others  Reading social cues  Accurate interpretation of social information  Basic social skills – initiating conversation, joining a group  Social reciprocity  Empathy

SKILLS:  Evaluation Skills  Intervention Skills  Advocacy Skills

EVALUATION SKILLS:  A sk questions  B e observant  C ollect collateral information

4 Basic Questions to Ask Everyone:  Grade level?  School District / School Building?  Special Education? and  Functioning?

Functioning  Questions to Ask:

Observation  Mental Status Exam  Attitude  Interaction

Information to Obtain from School:  Report Card Grades Behavior, Effort, Attention Attendance  Standardized Group Tests  Individual Tests  Teacher Questionnaires

Educational Testing  Intelligence  Achievement  Visual / motor  Language

Interventions  Define target skills  Set / prioritize goals  Measure outcome in behavioral terms

Interventions  Problem Solving Medical Interventions Home School Educational placement

Medical Interventions  Hearing testing  Vision testing  Meds at school  Medical input!

Home Interventions  Appropriate expectations  Organizational strategies  Consistency

School Interventions  Classroom Accommodations  Class Placement  Testing  IEP / 504

ADVOCACY Become Proactive Negotiate; don’t blame Communicate in writing; keep copies Keep file of pertinent information Consider request for independent evaluator Use Educational Advocate as resource

Individuals with Disabilities Education Act (1973) Criteria: Serious emotional disturbance Learning disability Physical disability Mental retardation Traumatic brain injury Autism Hearing or vision impairments Other health impairment  Eligible for Special Education services  IEP: Individual Education Plan

Rehabilitation Act (1973): Section 504  Schools cannot discriminate against children with disabilities  Less severe disabilities than IDEA but must have impairment that limits learning or social development  School must provide reasonable accommodations

Example: Poor Grades 11 year old female 5 th grade – Elementary school Regular education Worsening grades over school year Skills deficits: Problem focusing Getting into verbal battles with peers Sleep during class Poor attendance

Questions? Discussion?