Nerissa S. Bauer, MD, FAAP
October 31, 2017
The mother of an 8-year old patient of mine, who had a history of attention deficit-hyperactivity disorder (ADHD) and anxiety, recently came to me in tears because she "just knew something else was wrong."
Her son had been receiving therapies and services the past year. Since his initial diagnosis, the family wasted no time "going to bat" for their child. They got an individualized education plan (IEP) for him at school, found tutors and tried medication and therapy for ADHD and anxiety. Still, he continued to struggle.
Pulling out samples of her son's schoolwork, the mother's eyes welled up recounting his growing realization that he wasn't meeting expectations at school. She talked about his outbursts, the arguments with homework and the crying when he got home. We talked about supports in place, the challenges the boy continued to face and her increasing feeling of helplessness as each day went by as his fragile self-esteem continued to plummet.
In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HIB meningitis through textbooks (and some of my anecdotes).
This is the recurring story of vaccine preventable diseases.
- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf
"It’s estimated that as many as 1 in 5 children
have a language based learning disorder."
After consulting with a psychologist I work with, the child was diagnosed with dyslexia and dysgraphia--learning disorders that can occur alone, or in combination with behavioral disorders such as ADHD. Dyslexia causes problems with phonemic awareness (ability to notice individual sounds in words); phonological processing (ability to "pick apart" and discriminate differences in speech sounds); along with decoding, fluency, rhyming, spelling, and comprehension. Dysgraphia makes it difficult to write and organize thoughts on paper. Learning disorders are genetic-based neurologic conditions.
It's estimated that as many as 1 in 5 children have a language based learning disorder. As a behavioral pediatrician, I see the effects of undiagnosed or under-treated learning and attention difficulties can have on children's academic performance, interpersonal relationships and emotional wellbeing. I also see the toll it takes on families.
By asking about and revisiting how a child is doing at home and school, we have the unique opportunity to provide guidance and support. In a busy primary care practice, it can feel daunting to do this well when clinic appointments are brief.
"Ask about school and learning at each visit and
set expectations so families understand that any concern, no matter if trivial
or large, should be brought to your attention. "
Here are some tips and tools that may be useful:
- Perform a thorough history to understand the context of the issue. Remember your ABCs (Antecedent, Behavior and Consequence) and ask about circumstances that may have preceded changes from baseline functioning in home and school. Ask about therapies or treatments tried and their effectiveness.
- Ask families to bring in copies of schoolwork, prior testing and report cards. These items create opportunities to talk with the child, while pointing out their strengths and gently probing about perceived and real challenges to learning or staying focused.
- Introduce the concept of the child's "team" and identifying key players. At a minimum, this should include the parent, child, pediatrician and teacher. It may also include therapists, counselors and other specialists.
- Empower the parent to share new or ongoing concerns with the child's teacher using neutral language. Give parents conversation starters, such as, "Can you please share an example of your concern?" or "I am increasingly concerned about how my child is learning because [fill in the blank with a specific example] and I would like some guidance on what we can do to help him."
- Coach parents on keeping pertinent documents, such as IEPs, results of testing and therapist notes, organized in a binder that is brought to all medical/therapy appointments and school meetings so that everyone on the child's team are on the same page.
- Help families understand their rights and responsibilities, including understanding educational law. Reputable online resources including Healthy Children.org, Understood, LD OnLine and the National Center for Learning Disabilities can be used to share information with other caregivers and teachers.
- Connect families to local chapters of community organizations for children with special health care needs, such as Family Voices, for peer-to-peer, mentoring and advocacy support.
- Ask parents to help connect you to the child's teacher. Teachers provide valuable firsthand information of the child's functioning in the classroom and with peers. Reaching out to discuss ongoing learning or behavior concerns and keeping the parent-child actively engaged role models active collaboration and clears the path towards optimizing current therapies and treatment plans.
Learning disorders are easy to overlook, especially in the setting of other existing behavioral diagnoses. Ask about school and learning at each visit and set expectations so families understand that any concern, no matter if trivial or large, should be brought to your attention. Coaching families on their rights and how to become advocates for their children will have tremendous impact on children's overall social-emotional wellbeing and academic success.
The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.
Nerissa S. Bauer, MD, MPH, FAAP, is Dr. Bauer is an Executive Committee member of the American Academy of Pediatrics (AAP) Section of Developmental and Behavioral Pediatrics and is a member of the AAP Early Childhood Research Network Subcommittee. She is an Associate Professor of Pediatrics at Indiana University School of Medicine. She recently hosted an Understood.org Facebook Live "Ask the Pediatrician" event on learning disorders. Follow her on Twitter @nerissabauer and on her blog, Let's Talk Kids' health (www.letstalkkidshealth.org)