School-aged Children Who Are Not Progressing Academically: Considerations for Pediatricians

Cross posted from AAP News and Journal

Introduction

Pediatricians and other pediatric primary care providers may be the first to be consulted when families have concerns that their child is not making expected progress in school. Furthermore, pediatricians are confronted with an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties. They also provide care to increasing numbers of children with complex and chronic medical problems that affect the development of the central nervous system and have the potential to derail or divert the acquisition of behavioral capacities. In some cases, the problem can be sorted out through history and interventions conducted in a clinical visit. In other instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients’ academic functioning. Psychological and educational evaluations can provide valuable diagnostic information and inform strategies for intervention that address cognitive, psychosocial, and learning needs. Evaluation of these domains is accomplished in a variety of health care, community-based, and school settings. Assessment information may exist from previous evaluations, in which case the pediatrician’s role is one of review and analysis of results as they relate to intervention planning and ongoing medical management. In other cases, the pediatrician will refer a child for additional evaluation. With the information from in-depth assessments, pediatricians are strategically positioned to work in partnership with families and help them in collaborating with schools and other health care specialists.

Our purpose for this clinical report is to present a clinical approach to school-aged children who are not progressing academically. It complements existing American Academy of Pediatrics (AAP) clinical reports, practice guidelines, policy statements, tool kits, books, and case presentations that provide guidance regarding the early childhood age group as well as specific issues such as learning disabilities, mental health concerns, youth violence prevention, and foster care.121 In this clinical report, we first provide a clinical overview of school-aged children with academic progress problems, including the epidemiology, presentation, and differential diagnosis, and discuss the pediatrician’s role in identification and management. A more detailed review follows, with strategies pediatricians can use to clarify why, when, how, and to whom to refer for further evaluation as well as guidance on how to understand evaluation results, communicate findings with families, and integrate the information into clinical management. The clinical report is guided by the AAP’s medical home care-coordination framework22 and supports the pediatrician’s collaboration and consultation across service system sectors. The Supplemental Information provides resources for this collaboration, including coding and billing strategies to address the resource requirements for this type of collaboration.

It is important to acknowledge that the additional evaluation services for children can vary widely in how they are organized and funded across communities. Therefore, the content in this report does not indicate an exclusive course of treatment nor serve as a standard of care and may not be applicable to every professional situation. The suggestions are not definitive and are not intended to take precedence over the clinical judgment of pediatricians. Variations, taking into account individual circumstances, will be appropriate.

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