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

2. 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.

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

4. TOP SCHOOL RELATED CONCERNS?

5. 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grades  Doesn’t pay attention  Doesn’t seem motivated  Disrespectful  Doesn’t get along with peers  Seems sad, withdrawn, anxious  Gets sick a lot  Has poor attendance

6. Role of Family Physician Traditional Model Enhanced Model

7. 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

8. School Problems Diagnosis driven approach Symptom Diagnosis Treatment

9. School Problems Child FamilySchoolCommunityPeers SYSTEMS APPROACH

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

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

13. What Makes a Successful Student?

14. SKILLS!!!

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

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

17. 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

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

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

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

21. 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

22. SKILLS:  Evaluation Skills  Intervention Skills  Advocacy Skills

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

24. 4 Basic Questions to Ask Everyone:  Grade level?  School District / School Building?  Special Education? and  Functioning?

25. Functioning  Questions to Ask:

26. Observation  Mental Status Exam  Attitude  Interaction

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

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

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

30. Interventions  Problem Solving Medical Interventions Home School Educational placement

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

32. Home Interventions  Appropriate expectations  Organizational strategies  Consistency

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

34. 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

35. 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

36. 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

37. 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

38. Questions? Discussion?