I agree completely. If this had been the case, it would have saved our family from the traumas that we have been through over the last year with our now 11 year old son who has ADHD. For years we asked for help with our son from his pediatric practice. I have even walked in off of the street almost begging for help. The first time, were given a referral to a clinic style (any quality psychologist does not take insurance) psychology practices whose response was "we are not taking new patients and due to the volume of requests you need to call back in a few months". I found this response to be typical of most of my calls over the years, to both public (state funded and accept insurance), and private practice.
My son's school counselor told me for years that he needed a "therapist", assuming that much of his distress must be family related.
The story of my son and trying to get help for him ends with him being involuntarily sent to a psychiatric hospital last year.
My concern with this plan is that there are not enough quality programs to send the children who need evaluations. The evaluation fee ranges from $2000-$4000, and this does not include treatment. Going fees in NYC for behavior therapists are around $200-$300 per session, and it is recommended that the child go weekly. On top of that there is the monthly fee for the psychiatrist, which if you are lucky, CN be as low as $300. From my experience, getting the DOE to fund the evaluation can take up to two years.
If not for chocolate milk I don’t think I would have finished grade school.
Every child struggling with classwork should be given a hearing test.
My son found a dead rat and thought it was mickey mouse. He brought it to school and threw it into the class's hamster cage and yelled: "You're finally with Minnie!"
As a special education teacher, I wholeheartedly agree.
1
Any pediatrician I have met has not had any competence in this area. Bad idea.
3
I struggle in school and my doctor requested me opiods and I struggle from addiction
Really, what planet is Dr. Klass living on? If he is like every other physician -- you go to the office. Sit and wait. You are ushered into an examination room - you sit at wait. The aide or whomever takes the vitals. You sit and wait. The doctor finally arrives and you are telling me he is going to spend more than five minutes to have a lengthy discussion?
6
My daughter was diagnosed ADD and LD at age seven at Georgetown after extensive testing. When someone would ask me about ADD I'd ask them where was their the child tested. Daughters classmates parents were getting there child's pediatrician to prescribe medication to calm down the child with out testing of any kind. So sad!!
There isn't something medically wrong with every child that doesn't fit the cookie cutter school mold. We need to fix the schools, not fix the kids. Kids naturally love to learn, but many don't like this standardized curriculum shoved down their throats.
15
This is an important piece and long overdue! As a speech-language pathologist specialized in both oral and written language disorders, we are now struggling in the age of screen time, hours of technology and the aftermath of balanced literacy in our classrooms. Often children go under-diagnosed or misdiagnosed with language-learning deficits. Often, we mistakenly believe, as noted here, that if a child talks, they must be fine; if psychological testing demonstrates 'high verbal' skills, kids may not be properly identified as language-impaired.
Oral and literate language development development and disorders are complex issues but we now have decades of evidence-based research that elucidates both. The schools, burdened with reading and writing curricula that often ignores the research, the plethora of technological accommodations, and the teaching to the test models of learning and achievement, have 'disabled' many students. An important resource is pediatricians but not uncommonly, we do not marry informed pediatric speech/language clinicians with pediatric services. It is both a moral and ethical obligation to make sure that beginning in early childhood, children receive appropriate language screening - there are excellent models to utilize - consistent therapy when indicated that is also frequent, and understanding that the subtle as well as obvious deficits in childhood speech/language development, become the learning disabilities and their sequelae in school.
6
Children who struggle at school benefit most when everyone who works with the child - school staff, parents and other primary caretakers, and medical providers- are communicating and collaborating with each other. In my experience as a principal for many years, I can attest to the remarkable progress children make when this happens. The more complex the child's needs, the more crucial it is for all who care for the child to work together.
4
Just because something is good public health policy or involves child development in some way does not mean it belongs under the umbrella of clinical medical practice. Pediatric organizations and training programs need to be mindful of this. Of course an accurate assessement of reasons a child is struggling is important, and a part of that is clearly medical. But our training is not in bullying prevention or individual learning plans. Of course reading to children is important, but should the pediatric office be a lending library? (yes there has been guidance about book distribution to parents of toddlers in the past) In the context of this article, the following quote should be terrifying to the practitioner with some humility about their role in the world "I hear from the A.A.P. that you’re the person I should ask for help on this." Nope.
The list of anticipatory guidance topics grows and grows,
6
@Henry K.
Exactly. This just medicalizes every learning problem. Your kid can't do math because they have mathphobia or disgraphia or whatever.
Not everything is a disease. Just because you need to try harder at something before you get the hang of it doesn't mean you have a disease. It just means you have to try harder and keep at it longer until it clicks.
We don't send kids to doctors if they can't play basketball like LeBron James. LeBron James plays basketball well because he practiced much more that the other kids, and obviously likes it. Same with any gifted kid who's good at math, playing an instrument or whatever.
2
Much of what is advised in this article, such as poorly diagnosed ADHD instead of address learning disorders is well said. However, where I disagree is on the suggestion that pediatricians should do more than their fare share of treatment of children with clear mental health concerns, including learning disorders. All the pediatricians in my community health center are overwhelmed with managing diverse patient demands, and I know this to be pattern across the healthcare board. The answer to the behavioral and mental health concerns is to identify and reach out to the specialists: mental health providers, including psychologists, counselors, & clinical social workers. For example, psychologists are trained to evaluate for all the conditions mentioned in the article beyond the standard clinical interview. And if a parent is not satisfied with one provider, find another, as would be done if dissatisfied with a pediatrician. So with all this said, why put more on the plate of the pediatrician than they already have (assuming it's not a physical condition presenting with a child)? Parents should go to the specialists and pediatricians would do well by establishing close working partnerships with those specialists.
10
Awareness of the importance of adequate sleep for children of all ages is important for all health and mental health professionals. Insufficient sleep quality or duration has been associated with problems in learning and behavior. Sleep is an easy thing to ask caregivers about, and it's far preferable to modify sleep and bedtime routines than to jump to medication if indeed sleep appears to be an issue behind the presenting problems.
3
General Pediatricians often don't have the time or training to delve into a child's school problems. But Developmental and Behavioral Pediatricians, who are are Board-certified in this specialty, work closely with the child, the parents, psychologists, psychiatrists, and schools. In other words, they take a holistic approach to helping the child. If medication is warranted, they are trained in its proper use. It may be worthwhile for people whose kids are having trouble in school to seek out this type of specialist.
4
@pat simons
I completely agree that a Developmental Pediatrician who has expertise in this area, and can offer a team approach is ideal. That said, it’s only in a dream world that most children and families have access to anything close to that. Most developmental pediatricians work in large academic centers. Their clinical availability is relatively limited compared to a typical office based or clinic based provider. IF one can get an appointment it’s often months out, and the evaluation can take quite a while. Often there are clinicians in training ( all types) that are involved in the process.
For a complete system of helping children with learning disabilities, etc it would taken THOUSANDS more of developmental pediatricians, psychologists, and general pediatricians with more training in those areas and huge chunks of time in their schedules. It would take school systems with the will and vast resources to identify and treat these children with academic support, reading specialists, testing capabilities, etc. The costs to any one school district would be huge.
I agree that it’s needed, but very doubtful it will happen.
4
@pat simons That's all fine and good, but developmental pediatricians in my area have a 4 month wait list to get in.
1
Must we medicalize school failure? The answer is yes if the student has an obvious medical problem such as bad eyesight. But parents too eager to see their children succeed might put pressure on a pediatrician to produce a diagnosis that would allow, for example, extra time to take tests. There is also the risk of unnecessary drugs such as Adderall for putative ADD, or a label, such as autism or autism spectrum, that could, ironically, cripple a child's ability to succeed. Learning specialists would seem to be the obvious choice here, not a physician who might do more harm than good.
6
As a retired educator, I wonder if this is a matter of a wonderful idea with a multitude of things that just wouldn't work in the real world. Pediatricians would need radical retraining. The suggestion somewhat implies children are in schools that share common educational characteristics. Parents have widely varying attitudes about medications, success, etc.
The intent here is genuine. The implementation may be unlikely, except in a few cases with unique pediatricians highly attuned to each child in each school.
4
No. You bring the medical industrial complex into your kid's brain, you agree the child is 'flawed' and 'needs medication.' You agree for the rest of their life they will believe this and likely keep taking medication for their flaws. You taught them this, don't be surprised by the results.
5
Once again The New York Times advances the "blame the child, the child must be sick" education strategy
Could this writer consider that the issue lies with our school structures and practices? If a child can't pay attention he/she must be drugged into submission, it can't possibly be a boring class, awful furniture, or meaningless content. If a child struggles with reading it must be a disability, it can't possibly be that US reading instruction is cruel and mostly worthless. If a child can't behave, it's a mental illness, it can't possibly be school and classroom rules that essentially demand revolt.
When schools change the use of time, the use of space, the way they divide children, and the rules and structures of school, most of the issues that kids' have disappear. We must transform schools and stop trying to fight childhood and adolescence.
Ira Socol, co-author of 'Timeless Learning - How Imagination, Observation, and Zero-Based Thinking Change School' and 'Education Reimagined, a Space for Risk'
10
I hold a doctor that education learning disabilities, American University.
In a comment written about me, rewiring the brain by Kent Jackson standard speaker newspaper. Interviewed three people I worked with. A 78-year-old, a seven-year-old, and a 23-year-old. All improved in nine hours.
People demand A.. These people are so called gifted. They land in college they find out they are not so-called gifted and many commits suicide because they cannot make a B or a C.
When I told my attorney that he started to hire attorneys who graduated who made B and Cs. He stated They work and they work harder.
We put our daughter in school earlier. Another person had problems with her eyes. They kept her outfit two years. That girl was three years ahead in school! That person got all of the awards. Yet 10 years later she did not know what she wanted to do. My daughter who struggled is a Nike designer and designs male shoes. And if you like fingernails you might pull up, you don’t need a man you need a manicure. Stress is needed.
And be well aware eye exams are not correct. It helps to cause a ADHD double reading and slow reading and that can be cleared up in nine hours of work. The times printed these comments in the past.
“If we’re kind and empathic, it helps a lot,” she said. “They’re not doing this because they’re misbehaving — they’re working to their capacity.”
Amen.
Kids often don't need to try harder--they may already be trying harder than their peers and baffled as to why they're not succeeding. Then they start to feel horrible about themselves.
We have a culture that is quick to assume laziness or bad parenting--too quick to diagnose ADHD as if that were the only reason for focusing problems. Then the pressure to medicate is on.
Having teachers who have no idea what slow processing or sensory processing issues are means the parent and student have to educate them. It's hard to self-advocate when assumptions about why kids aren't doing well abound. It's easier as they get older and more confident. Parents, don't assume it's ADHD or your child isn't trying. Do more research. Ask your child WHY it's hard for them to do certain things. Go over classroom tests and why they answered questions as they did. Get curious. You can learn a lot. And insist on a special ed evaluation--none of this getting stuck floundering in RTI!
7
How about talking to a psychologist? Pediatricians are not trained, nor licensed, to assess school performance or behavioral issues. I am sick and tired of how the medical profession is assumed to be the only and best at assessing anything and everything. Call a psychologist, particularly a school psychologist. They will suggest a medical exam to rule out any medical issues, but are in the unique — unique —position to assess cognitive and behavioral concerns. By licensure. Unique.
18
@kathpsyche I agree with you. However, pediatricians accept insurance. Psychologists don't. Until you fix that problem more parents will go to their pediatrician first before they go to a psychologist.
3
@Diana You have a point although there are many psychologist who take insurance. But to get at the heart of you criticism, insurance companies pay significantly less reimbursement to psychologists compared to other healthcare providers, including pediatricians, so there's very little incentive for psychologists accept them (i.e., they have to make a living too & why should their specialized health service hold lower value). Having consumers demand to insurance companies to panel more psychologists is one solution to this problem.
For families who struggle with a child with a behavior or emotional regulation problem, even knowing the difference between a psychiatrist and psychologist may be a learning curve that the pediatrician should help navigate. The cost of an evaluation in the NYC area is between $2000-$3000, which is shameful, so finding the correct first step is crucial.
Yes, but how about a story asking teachers who now must juggle piles of IEPs daily about the effects of devices on children's attention, or the immediate effects of sugar on behavior? Before burdening your kid's teacher and classmates with yet another IEP, limit screen time and reduce sugar. Who spends the most time with your kids? Unless they're homeschooled, it's not you or your pediatrician.
3
Yes! Screen and sugar are so detrimental and another obstacle for educators to overcome. Thank you for saying this.
1
I have seen how doctors "help" children with problems at school, diagnose, Attention Deficit Disorder, when the real problem, if anyone had bothered to ask, is too much T.V. or video games. I've seen what hour and non stop watching does to children; it makes them sick and doctors just pass out the meds. 1 out of 7 children in Maine are taking meds.
2
I find this slightly offensive as a parent of a child with quite sever neurological issues (ADHD). His disability is most certainly NOT caused by excessive screen time, in fact, ADHD makes screens all the more problematic. This is the type of assumption that keeps children who are struggling with neurological problems from getting the help that they need.
1
I agree with a wholistic approach to helping children who are struggling. I am curious as to why there is no mention of parental influence in this article. In my 32 year career, the onus has shifted to people outside of the nuclear family like public schools and doctors to be the ones responsible for helping children. We are most certainly an integral part of the picture, but without parental support and accountability, we are not addressing the whole child. As I attend IEP meetings and 504 meetings, I see a long list of what the school will do to accommodate the child's needs, and an increasingly short list of parental responsibilities. It is important to recognize that often times parents reject the advice of educational professionals and insist on accommodations that are detrimental to the child's success. I have also witnessed chronic absenteeism that is condoned by the parent. I am in no way stating that it's all the parents' fault, but merely pointing out that it must be a team approach that holds everyone accountable, not just the teachers and the doctors. We do all we can during the school day, and parents need to do all they can at home.
7
As a parent of a child with full blown ADHD/ODD, I will tell you that it is difficult for a parent to be involved unless it happens to be the parent's area of expertise. I am not a mental health professional, or an educator. I have very little experience with children other than my own. When our son was very young, he was already showing very difficult behaviors such as aggression. We were desperate for help, and assumed that the school could help us understand what was going on and give us suggestions for outside services. We trusted and deferred to them early on, until we finally realized that they seemed to know little more than we did about the complexities of this neurological dysfunction and how to treat it. As I became more knowledgeable I ended up advocating for my son and having to butt heads, and call in advocates.
Schools should have one number that they refer parents to to get outside help. And this number should have someone on the other end who answers the phone and gets an appointment made with a highly trained professional who actually starts a treament process.
I am sure pediatricians who are generally slammed taking care of children with acute and chronic medical conditions are thrilled to have this ball tossed into their courts. Just thrilled; especially as this is not their area of expertise. You know, it's a slept at a Holiday Inn kinda thing when a physician is asked to evaluate school performance without seeing a child in that environment. The bad idea bear is at work here.
8
@Gayle I agree pediatricians have too much on their plates, but the examples of kids being quickly diagnosed with ADHD and medicated are food for thought. Pediatricians can play a big role in getting parents to question and investigate what's really going on.
2
You may have found some pediatricians for your article who truly "get it," but most are neither trained nor equipped to make educational diagnoses. If a child needs, say, a neurodevelopmental evaluation, or a geneticist, or a psychiatric evaluation, go to the doctor. If they don't, educational professionals such as psychologists such as school psychologists, speech-language pathologists, and occupational therapists, are the ones to diagnose and treat educational disorders. My evaluation as an SLP involves observing the child in the school, talking to the teachers and parents, figuring out what the appropriate type of assessment tool is, developing enough of a rapport with the student to get valid results, administering and interpreting the carefully selected tests, and reporting my findings.
5
There are people who do what is recommended by this report everyday.
They are teachers, administrators,
Counselors, school psychologists, and paraprofessionals.
These professionals have devoted their professional careers to figuring out what is hindering success for students, and developing programs and plans to help those students succeed.
American public education has been under attack for the last 50 years. The continued discrediting of this field has got to come to an end.
9
This article has a tone that sends the signal to parents to distrust those involved in their child’s education or care. Don’t ask your child, don’t talk to the teachers, bypass the school board or administration, don’t consult the school psychologist or counselors. Assume everyone else has been unqualified or unworthy, and schedule an appointment with the pediatrician, who may or may not have an opening within the next few months (a life-time to struggling school aged children).
8
Instead of talking to the pediatrician when your child isn't doing well in school, talk to the kid. They can tell you more about exactly what they are facing than a doctor. If they tell you things that might be symptomatic of a learning disorder, then it's time to bring in the doctor.
9
@Elizabeth Garnett
You can talk to your parent AND request a peditiatrician referral for a clinical/developmental assessment.
Asking a child who may have autism, learning disability, processing, and/or language-learning differences
why they aren't "doing well in school" may not yield enough information.
1
The article makes several good points. However, it fails to delve into two critical issues:
1. If doctors are going start exploring and assessing problems students are having in school, they will need to develop a deep understanding of school design, education and, especially, the research into how people learn.
2. Any analysis of students' lack of success in school must include the possibility that it's the school that needs to be fixed, not the student. I wrote an article on this subject: "Brains and Schools: A Mismatch," Education Week, Sept 10, 2013.
14
As a Learning Disabilities Specialist for 30 years I have had contact with many pediatricians. I discovered that their training includes almost no comprehensive understanding of educational problems. They often do not take the time to search out resources in the community to assist parents with their child's specific school related difficulties.
Unfortunately ,the doctors do not have or are unwilling to take the time to first contact the appropriate personnel at the school. Almost all school systems have a school counselor or even a school psychologist and educational specialist on staff that would be most willing to confer with parents and to provide specific assistance with the child's problems.
A joint approach is the best way to deal with youngsters having learning issues. Including the pediatricians provides the best comprehensive evaluation to gain an insight into the problems and to explore the best treatment plan.
When I was able to interact with the child's doctor, there was a much more successful result!
15
I'm not sure the pediatrician is the correct person to diagnose and/or treat learning disabilities, but if they have been in the community for a significant amount of time they are likely to have a long list of referrals. The school district was never helpful to me or my child in this regard.
7
@479 Pediatricians don't diagnose learning disabilities. My son's in college and can't get accommodations from the disabilities office like e-textbooks for free unless he has a medical or psychological diagnosis (ADHD, Generalized Anxiety Disorder, etc.) An LD doesn't count.
Be very wary of your child receiving the ADHD (mis) diagnosis. You can never pass an FAA medical exam and be a pilot.
5
Pediatrician mostly useless for behavioral isses
4
No what is wrong with people? In the age of overprescribed pills and conditions this article is nothing but a shill for pharmacies.
You should already know if your child has a serious condition! This is an awful thoughtless article, go bring your child for checkups and evaluations, don’t start looking to your MD to make something up wrong with your kid because they don’t do well in school!
Atrocious piece of journalism.
6
@D Collazo
Calm down. Many times the child's difficulties go unnoticed until third-fourth grade. We can't expect parents to know if their "child has a serious (condition)".
Rather than getting outraged and assigning blame,
let's guide families to the most efficient, helpful process.
The first-line professional who should be consulted about school issues for a child is an educational psychologist. That specialist is familiar with the full range of emotional, social, and cognitive issues children face.
If your child is struggling in school, start with a request for an initial consult with your public school's educational psychologist. Bring a record of your child's experiences, work samples, teacher reports, grades, and the child's own descriptions of what's happening. Be prepared to explore options for further inquiry. The psychologist may conduct particular screenings or tests, or refer you back to a physician for more medical screening.
If your child attends a private school, you may have to find and pay for this service yourself.
With all due respect, pediatricians are not educational experts, and see most patients for at most 15 to 20 minutes during a visit. Do no rely on a medical doctor for an educational problem.
12
I wonder why this author chose the term "intellectual disability" over the more widely-used term "learning disability."
3
@Merula They are entirely different disorders. Intellectual disability is what used to be known as mental retardation, and learning disability (which is the lay term for specific learning disorder) refers to a disorder of math, reading, and/or writing skills.
11
@Kel In fact, the phrase I have heard (and which is more accurate) is "learning differences." My grandson struggled in a traditional primary school in Vienna with a very short school day, was first analyzed (entirely stupidly) by a psychologist, then went to another one, who helped him a lot with concentration and other issues but not much with dyslexis, discalculia and others like that. After graduation from primary, he had a good year in the American Independent School, catching up on a lot, but it was when the family moved to London and lucked into a school with unusual approaches to the varied ways that kids learn that his progress began to soar. That, and the help of various family members, has made a world of difference for that extremely intelligent, creative and (now) academically successful boy. He still must work very hard to achieve what some kids can so with little effort, but getting the right conclusion about the nature of the problem (I knew what it was, but I'm no expert) and being taught approaches to learning that are effective for him changed him in so many ways, He is now a happy teen and enjoys going to school, where he is succeeding beyond his or anyone else's expectations.
2
@Merula As the other Kel above noted, in education these are two different situations which require different types of interventions. Students with an intellectual disability have low cognitive, social, and academic abilities across the board, while students with learning disabilities have typical abilities in some areas, but low scores in some areas. They are discrete educational diagnoses, which is why the author chose the term, since that is what she was describing. Individualized Education Plans, the documents that lay out the student's needs and required services/accommodations, have a variety of different educational classifications, and ID and LD are two of them.
1
Pediatricians have virtually no training in pedagogy. They are most certainly not the first professional to turn to if a child is struggling in school.
11
There is a weird idea that because "pediatricians" are considered "experts in kids" they know all about everything that might befall a child. That's a ridiculously heavy burden for them to bear, and patently not the case. Go to your pediatrician for weird communicable diseases, and care in the hospital for a desperately sick child. Don't go to them for developmental advice if your child is not progressing typically. They aren't trained in it, and don't know much about it.
11
Dr. Bruce Lamphear MD MPH FAAP points out that very low levels of lead contamination can contribute to neurological disorders, loss of IQ and such things as aggressive behavior, ADHA, autism in children. The EPA is still peddling the lie that the lower the dose the safer the toxin. It is now widely accepted that there is no safe level of lead in children. 100% of US children are exposed to lead and many other toxic chemicals known as endocrine disruptors. Once the damage is done there is no cure. Prevention is the only cure but policy makers seem to avoid this solution and focus instead on finding miracle "cures".
4
I'm not sure that a pediatrician could have helped my daughter with this situation, but a "poor fit" between teacher and student can be a real problem.
When my daughter was in 1st grade, her teacher insisted that she was lagging behind in math (although she was doing well in other subjects) and believed she had some sort of disability. Well, after many months of tests and thousands of dollars spent, it turns out that this little girl was simply bored to tears by the rote assignments the teacher gave.
I insisted on moving my daughter to another classroom. Within months she was getting all A's in math. Many years later, she graduated 6th in her class of several hundred, got an SAT math score of 780 (verbal 800), and went on to recently complete her PhD.
Parents, you know your children better than anyone else does. And don't be shy about being an advocate for them.
10
New York City has psychologist assigned to every school primarily for the purpose of evaluating learning problems and making educational recommendations, called an IEP - Individual Educational Plan, for students referred. The school psychologists are not only trained with a great deal of experience evaluation children with learning problems, they are also very familiar with the services offered.
I urge parents concerned contact their child's school Parents, even parents with children in private schools, have the right to request these evaluations.
9
The pediatrician should be referring out to a child psychiatrist who is best equipped to diagnose and treat ADHD and its comorbidities (which are many, especially if the child has been un/under diagnosed for a long time). Unfortunately, child psychiatrists are even more scarce than adult psychiatrists, so it is the pediatrician who ends up taking the case, so to speak. These children do best with a multidisciplinary team in conjunction with cooperation from the school.
4
The child psychiatrist is not necessary many times and the difficulty is more than unfortunate. Sometimes insurance companies limit their panels which in this environment is criminal, IMHO.
As a remedial reading teacher I suggested to parents that they always discuss learning and other issues with their pediatricians. ADHD , while common, cannot be diagnosed by a teacher or social worker and neither can prescribe meds if needed. Sometimes major psychiatric intervention is needed in the form of therapy and medications. Many parents are resistant and suspicious. This is a disservice to children who are truly suffering and could be helped.
8
a lot of dyslexia stories - not diagnosed until much later - some become billionaires - Virgin's Richard Branson, etc.
I picked Asperger's in one student - laser focus to the exclusion of socially appropriate behaviour.
6
Pediatricians are of minimal value. They can rule out common physical ailments, but be prepared for a boilerplate and over-simple ADHD diagnostic worksheet -- we were given one and it literally had "(c) Pfizer Inc" on the bottom of it.
After 4 referrals involving 3 psychologists and a social worker, we finally wound up with a diagnosis of ADHD after about 3 years of consulting professionals. It wasn't something we tried to get, but unless your child is obviously having major problems all diagnoses seem murky and open to interpretation.
Our son takes Adderall and he believes his inability to focus is being helped, I'm just skeptical of the whole process. Ambiguous diagnoses, multiple practitioners and finally a psychiatric drug being administered by a pediatrician who isn't primarily trained in psychiatry. All for a kind of marginal return in terms of tangible improvement.
5
@Mobocracy Unbelievable you choose to drug your child so Pfizer can make their billionaire CEO richer.
The great news is that there are school psychologists who are specifically trained to address challenges faced by children and the best part about it is that they are actually in the environment in which the kid is struggling rather than a clinic.
Instead of heading to your pediatrician who may or may not have training in socioemotional, behavioral, and academic interventions and supports, ask your student's school staff if there is an SP available to look into the struggles your kid faces. The SP should do or coordinate these things: interview your student, observe them in multiple contexts, interview you, interview several teachers, administer relevant assessments, help staff design and implement supports PRIOR to making a determination (i.e. a classification or a diagnosis). If your student is still not progressing, then a more in-depth evaluation may be warranted.
Identifying what is going wrong for a kid in schools should take time, involve multiple informants, and identify environmental factors that are impacting the student. I don't know any pediatricians who are able to spend hours gathering first hand data INSIDE schools.
15
@Prancing Deer We were failed by a school psychologist and a school social worker. Despite several visits they missed my son's serious depression, anxiety and learning disability issues. His academic problems were characterized as lack of discipline, laziness and lack of maturity. It was only after a complete nervous breakdown as a college freshman that my son got the diagnosis - and the help - he needed since he was a about ten years old. To date, my biggest regret is listening to the "school experts." Their insights and expertise was dangerously wrong in the case of my child.
9
School psychologists are some of the most overrated, inexperienced people your child can see and they work for the school first not the kid or the parent.
If you have a real concern about your child, pay the money yourself and see someone outside the school. It is not that expensive and you’ll likely find someone with far more experience. And they WON’T spill you child’s confidentiality at school like a school psychologist often will.
Your school psychologist is the least qualified and helpful psychologist your child can see.
2
@Sophie I'm really sorry to hear that and I am really happy that your son is getting the help he needs. I think it is reprehensible, unprofessional, and most certainly not evidence-based practice to characterize a student's academic problems as derived from "laziness" or "immaturity". This is shoddy practice and unforgivable that the school sanctioned such findings.
2
Though this is a great idea. I see problems on several fronts. First having a parent who is willing and able and let me stress able to try and figure out what is going on with their child who is all of a sudden not succeeding academically.
Then you need the health insurance to help pay for all of this. Because I am sure this is not free.
If you can pass those hurdles, the next is finding a Pediatrician who can actually do this. You need a Doctor who is not only extremely intelligent but who also has a passion to solve problems, has a network of co-workers who are just like them. If you are a person of color you need to make sure your Pediatrician is not biased against you.
The main problem is we are not a country that values mental and emotional health and we do not value our children.
I absolutely love this idea but I am afraid only the well to do who are willing look outside the box will embrace this.
9
What training are pediatricians receiving? Most teachers are not in a good position to intervene, so why in the world would we think pediatricians are?
The medical model is not an appropriate framework from which to address many classroom issues and can be downright harmful--and that's what physicians are trained in.
Physicians would do better by being humble and sticking within their areas of expertise.
12
The one person who has and has had your child’s interest at heart for years may be your pediatrician. The one who has the broadest and deepest knowledge of medical issues regarding children may be your pediatrician. The one who may know, from one perspective your family dynamics and where you would pursue help may be your pediatrician. The one person whose job is to be your child’s advocate is your pediatrician.
In all this, the parent must be the child’s advocate in order to seek out the best care.
To tell someone not to seek out or ignore their pediatrician’s advice and not a physician themselves is practicing medicine without a license whether enforceable or not.
We found the pediatrician to be useless for behavioral problems. We started with her like everyone recommended. She didn't do anything. I would expect the medical doctor to rule out any of the differential diagnosis prior to referral for evaluation. She didn't do any of that. The quack she sent us to was immediately available but said nothing wrong with a child who has developed a fear of school, birthday parties, friends, anyone who isn't parents or siblings after asking 10 questions.
It took months to get into a another doctor. She didn't multiple hours of testing and found ADHD.
In the meantime, we mentioned the sleep problems to one of his other doctors. The pediatrician has ignored complaints for years. The other doctor immediately referred us to a sleep doctor. Both the bloods tests and sleep study came back with conditions that can mimic and/or cause ADHD. We are now going to other specialists trying to figure out what is causing these conditions.
I have talked with several other parents whose children have diagnosed with ADHD. None of them had any blood testing or evaluation of sleep issues before being diagnosed by the pediatrician or referred to a psychologist despite having sleep issues like my child. These are different pediatricians so it isn't just one of them ignoring the other conditions that are evaluated before calling it ADHD.
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@FL Mom What blood testing is helpful for ADHD? Sleep testing can be helpful, but there's no blood test that eliminates or diagnoses ADHD.
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@Diana very good point. the diagnosis of ADHD is in the DSM manual of mental disorders. as with any mental disorder, one criterion for diagnosis is to rule out a medical condition causing the symptoms at hand. so with adhd, if you meet criteria based on DSM, and you do not have findings suggesting a medical condition responsible, you do not need blood or other tests. many conditions may mimic adhd and adhd may coexist with many other conditions as well.
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@ FL Mom,
My son’s behavior changed drastically when he started 1st grade at a new school. He became restless and very emotional. The teacher told me she thought he had ADHD because he was fidgety. Our pediatrician, upon hearing the experienced teacher’s opinion, prescribed Ritalin. Within weeks our son was worse, when we visited Disneyworld he burst into tears afraid that something terrible was going to happen to his little sister if she rode the Dumbo ride. After that episode, I learned from the pediatrician that stimulant drugs can frequently exacerbate an underlying tendency, in my son’s case, anxiety. He referred us to a child psychologist for a better diagnosis. Sleep problems can be caused by anxiety, so I would strongly recommend you consider this. Early intervention to determine the causes, if there are any specific ones, so they can be addressed, and/or CBT can help with its management and improve life considerably.
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It is a sad state of affairs when "a mental health" person makes a diagnosis of ADD with one test. I'm certain this person wasn't a clinical psychologist.
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as a general pediatrician, I see a lot of children for these kinds of visits. most of the time, they do not have a medical (meaning, non psychiatric, non adhd) problem that I myself can treat which is causing their school underperformance, at least that we can elicit in the short visit. I can't tell you how many families tell me they have asked for an evaluation from school and the school hasn't/won't/can't do it. most of the time as a pediatrician I am filling the role of child/family advocate or social worker. I have prepared a form letter I give to families stating I agree with their request for evaluation of the child based on the child's symptoms. Yes, I evaluate for ADHD, and sometimes have to treat it with medications. Would I rather the child with adhd also got psychotherapy as well with a psychiatrist? Yes. But good luck finding mental health providers particularly in underserved areas. I have my social worker help as much as possible with parents trying to interact with principals and teachers. But the general sentiment is right that there seems precious little someone with my training can do when public schools are underfunded, crowded, and struggling in their own right to educate children with increasingly complex psychosocial backgrounds and adverse childhood experiences, as well as poor nutrition and other challenges.
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@MD Do psychiatrists do therapy with ADD kids in Texas?
In NY 99% just prescribe meds (outside of hospitals).
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@NOOK as far as I know, in the medicaid population, psychotherapy is sorely lacking. just meds mostly.
I know several pediatricians whose own children are such train wrecks I wouldn't trust them with a failing child.
Start with the school. I have yet heard of a school so callous and budget-conscious to refuse to admit a child is in trouble. They are required by law to do this and they do take it seriously.
Not all children who are failing have terrible families/home life or diet. Many are just super-sensitive and don't do well in a large classroom environment. Children today appear to not have a lot of resilience. One child in a family may have, but another child may not. It will take the school and a therapist to sort this all out.
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@India
and include looking at the whole family. Look at the reasons one child does well and one doesn’t. What’s the Family process? Until we look at that we are going to continue to get what we have.
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@Whatever Often it's just that the two children have very different temperaments. One is tough as nails - very resilient; the other very "soft". Just born that way.
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As a special education coordinator, I found many pediatricians to seek evaluations and services that run counter to special education law. I would counsel doctors who want to make a difference to become part of the school team if they want to have an impact on a child's education, rather than prescribing interventions that the school can't lawfully do, such as diagnose a learning disability without evidence. join the village seeking to raise the child!
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Until we look at the whole picture & include parents & family dynamics, this continues the process of focusing on children’s “behavior” w/o looking at what’s going on at home. Quite often children evidence that there are underlying family challenges. For ex: If they are struggling with a death or loss, the whole family is struggling.
Focus on helping the adults in the room. They are contributing. I’m not saying it’s their fault. They contribute by how they respond to the child and that includes teachers, doctors, society.
I know this post probably won’t be popular. Im pretty sure people might proclaim I’m not empathic. Good. Empathy is getting all of us in trouble.
Figuring out what is going on with the child is only a start. If we stop there, we’re missing the boat. Parents, teachers and doctors often want to “fix” the child or even worse “fix it” for the child.
Why would we look to the child to determine the teacher is not good for them? Maybe the teacher is great for them because they learn to navigate difficult challenges. If there is teacher that’s affecting everyone, figure out how to deal with teacher.
I’m not saying don’t assist. Assist by all means. But labeling the child as having a problem is what we’ve been doing for decades. If it’s getting worse, it’s not working. And it’s getting worse.
I teach college and by the time students get to me many label themselves as sick, unfocused, etc. seeing themselves as victims. Do we need to keep perpetuating that?
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You are so right that the problem is more complex than just testing the child by this person or that and believing the diagnosis is clear. Each family is different and that needs to be considered in each child. A large part of the outcome for all these children is how people respond to them.
I feel this was written about me! Through my lovely 8 year olds early years, I often had concerns about her development.
Meltdowns were put down as too much attention from mum. Her lack of coordination was clumsiness. When she didn’t have any stamina, she needed more exercise. She can’t run faster than a gentle trot. She got a concussion after falling and not using her reflexes to break her fall. When she started school everything was hard.
The luckiest day of my life was when someone said ‘you need to see a developmental paediatrician’ ... what’s that?
We waited 6 months to see one of the few in our city.
She was methodically tested in a whole range of things .
Turns out she has mild cerebral palsy, but it was not noticed because she taught herself to walk. she’s got inattentive ADHD. Respiratory allergies were so extreme she wasn’t getting enough oxygen. Her vision is perfect, but the muscles in her eyes tire after 1 minute and she has to look away. The physio explained that when she runs it feels like she has 2 pulled hamstrings. She wet the bed because she sleeps so deeply, a result of those ‘2 pulled hamstrings’.
Add these medical issues together and ask a teacher to explain maths to her? No wonder it wasn’t working.
My point: how many other children have these issues, undiagnosed? We would still be frustrated and confused. Instead we are resourced, empowered and she’s on track, learning and happy. A medical diagnosis is exactly what is needed sometimes.
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While a physician may help to pinpoint the physiological variables that underlie challenges for children, parents should turn to a competent behavior analyst for "what to do about it". Behavior analysts are uniquely positioned to understand behavior in context, identify the functions of the behaviors of concern, and design a way out of the dilemma.
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@David Powsner find one outside of we’ll do do suburban areas near academic centers
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Our daughter did great at school until one day she didn’t. We struggled as a family and she struggled as a kid and the school struggled to help us. We went to a child psychologist who asked me if maybe she was just spoiled. So we tried to get tougher and it was absolutely horrible. We went to another dr and long story short, she is extra smart, has anxiety, and has adhd. Any of these on their own can cause problems and together, combined with puberty.... BOOM.
I was so relieved to get these diagnoses I cried. And yes we did meds and yes they made a huge difference. To her, and to our whole family. If your gut says something is wrong or if a crisis occurs, go get help! And keep going until that help actually helps!
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I used to teach the kids in the very lowest level high school English classes. One thing that struck me year after year (over the course of perhaps 15 years of teaching such classes) was that when I would ask the kids what they most liked to do, or wanted to do in the future, the most common answer by far was “sleep.” I was never sure if they actually weren’t getting enough sleep, or were suffering from depression, or were undergoing abuse of some kind that made them not want to be conscious, or what. I often thought that there was something going on there that medical people might be able to examine in a way that I in my role just couldn’t.
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I wonder if typical pediatricians have the training to recognize or diagnose learning disabilities? There are so many misconceptions out there about how children learn. Ideally, they should be paired with a trained psycho-educational specialist. Of course, this is much more common in middle to upper class communities.
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@JConway An excellent point, although according to the Individuals with Disabilities Act (IDEA) and the "Child Find Mandate", all school districts have an obligation to "locate, identify, and evaluate" all people birth to age 21that may have a disability. This applies to ALL students (private, public, homeless, migrant, wards of the state, etc). Full psychoeducational evaluations are the right, under federal law for all children suspected of a disability that do not demonstrate progress when provided with evidence-based interventions implemented with fidelity.
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@JConway a relatively simple series of tests can eliminate dyslexia [visual and auditory] - a not uncommon problem.
@JConway You are so right, but there are so many reasons that a child may be having trouble learning, or paying attention or fitting in, or anything else. Some difficulties are physiological, some psychological, some chemical or almost any other thing imaginable. We are lucky, because my grandson ended up in the right environment for him to maximize his potential. despite several learning differences (such as dyslexia, dyscalculia, short-term learning deficit and more). He is in a school with a very challenging curriculum but enough approaches to learning to allow him to have progressed after primary school in Vienna from a child who was considered lazy and stupid (and considered himself so, too) to one who loves the school in London that he now attends and is succeeding beautifully. We were very lucky, though, to have found the right school (it also is excellent for many other kids, including, most of them, ones with no learning differences) and that I inherited enough money to be able to send him to that school. But he also is to be complimented for his persistence, his willingness to discipline himself to do work even when he feels discouraged and to believe in himself and the adults around him who encourage and help him. Success stories aren't always easy to come by, but happily, they can be found even in unexpected places and ways. It's not easy, but it can happen.
The real crime against kids might be the over diagnoses of A.D.H.D. and the drugs that follow. It’s absurd to think all kids learn alike.
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When doctors are making judgements about bullying in school, diagnosing people as victims of racism, declaring guns a public health issue, its their ‘god complex.’ There’s a terrible shortage of pediatricians / family doctors yet they want to expand the scope of their work, preempting professionals trained for these fields. Another case of mission creep for some organization (in this case aap) who wants the world to know how socially progressive they are. Please get their hero awards ready.
And yes some kids just get C’s in school and no amount of expensive intervention will turn them into Fulbright scholars. Unless of course we dumb down the metrics by which we measure achievement. (See annual celebration of increasing graduation rates and declining suspension rates which mean absolutely nothing)
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@Andy Deckman
Don’t know too many pediatricians with “god complexes” - wrong field for that mentality-> if you can find enough specialists let me know-> we need them! Oh wait- their lead time is at least a year for an evaluation!!!
We’re in the trenches advocating for all kids - if not us who, if not now, when
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@Andy Deckman When my son was about 13, he began complaining of headaches. We took him to the pediatrician, who, after an examination, asked if he was getting teased at school. My slender, bookish child nodded silently. Just admitting it was a relief.
If this was “expanding the scope” of his work, I am still enormously grateful, a decade later. He could have sent us to another professional (and if the problem continued to warrant it, we would have gone), but instead he helped us understand what was going on right away. If a doctor can see that, why make things more involved for everyone?
(And yes, I think he deserved a “hero reward”. You sound resentful.)
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@Andy Deckman How could guns *not* be a public health issue? Good Lord, kids get slaughtered daily in the US, sometimes at school but also at home.
Kids find guns their relatives or the parents' friends brought in, and use them to shoot themselves, siblings, friends, or parents.
Kids get killed in their own homes by bullets that go through a window or even a wall. They get shot on their way to school or sitting on the front step.
Kids watch their mother being shot by her husband or partner.
Kids who survive these things have PTSD from living in the NRA's America. At school, golly gee whiz, they have a hard time concentrating!
Every doctor in the country should be asking about guns in the home. Every politician should be working to overturn the 2nd amendment.
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I taught reading, language arts and social students, GED and preschool for thirty-three years. I also tutored children on the side. Every one of my tutoring kids was exhibiting profound social problems at school, from acting out to not talking at all. It took about a year and a half of twice weekly meetings to get them on track. Example: one native American child was repeating second grade. Per request of the tribe I visited him in school. The teacher had the children seated in the classroom by the lowest reader to the highest reader row by row. My little guy was the lowest. I suggested to the tribe that he be home schooled by a nice family that had older children and were glad to help him out. He later reentered public school and graduated in to top ten students. Falling behind in school can have devastating consequences and intense intervention can really make a difference.
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And what do pediatricians know about school success? There are other qualified professionals and non-professionals who can truly help.
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I have seen thousands of children as a pediatrician and discuss their school experiences with each and every one every year and discuss their family dynamics and try to understand their learning pattern if they are having difficulty. In those 50000 or so visits I have listened and asked questions and have learned s lot of things in the context of all the possible medical diagnoses and have developed trust to advise testing when needed read reports that are simplistic and encouraged people to seek other opinions in an environment where there are few resources.
There are many pediatricians that wayI have had school systems recommend to parents to change pediatricians because I won’t prescribe medicine without a school evaluation.
There are plenty of professionals who have their own niche and people often will treat the nail with their hammer. There are many that are very very good as therapists and evaluators who can collaborate.
For ADHD for example, as another commenter wrote, no diagnosis can be made if there is another explanation for the findings and there almost always is a comorbidity.
Your comment is superficial and suggests resentment. You learn more by listening than by reading or talking.
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Finally, Pediatricians getting in on the 'act'. As a retired teacher, I can attest to all the reasons a child doesn't learn on schedule and the article is right on. Try teaching a child with a broken home, a missing parent (abandonment!), poor nutrition, no place to do homework or study, and no emotional support to do well in school. Anger issues result and it is a real challenge to get to the underlying problem and address the issue. Teachers by and large do their best.
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@Piemonte - I understand all of that but fail to see how a pediatrician who has only seen the child perhaps 15 minutes at a time twice a year would be able to help with those issues. Marriage counselors and financial planners might have more to offer.
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@tom harrison
A substantial portion of my day (mostly uncompensated) is spent on these issues. This is true for most of my fellow pediatricians especially in rural commubities .
Learn more about how the practice of pediatrics has evolved before spouting uneducated generalizations!!
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@Mark Fishaut MD
What, precisely, makes you and the typical pediatrician better prepared to address these core causes than the professionals trained to do so which tom harrison mentions?
You've not contradicted any of his points with evidence. That you spend most of your time doing it doesn't mean you should or that you are better prepared than others to do so. One would think this is obvious, but apparently it needs to be said.
School district's have an affirmative duty to seek out children in need of assistance under the Child Find obligation set forth in the IDEA. They aren't usually compliant in this realm.
A parent, when concerned, should request a school district issue a Permission to Evaluate for signature. It is imperative that the request be for a comprehensive evaluation to determine all areas of suspected disability.
The school district has 10 days to issue the permission to evaluate. They may decline, but must put in writing the reasons for declination and parent remedies, i.e., due process.
If the school district properly issues the permission to evaluate they have 60 days to complete the evaluation. Hold them to that timeline!
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The school director overheard me saying the following to the parent of one of my struggling students ( 2 plus grades below his appropriate reading level in second grade, low grades in general ) " Do you have a good relationship with your son's pediatrician ? You might want to discuss Emilio's struggles in the classroom. After all, pediatricians see a wide range of children and issues in the course of their practice, and your doctor is a resource who might have some insights for you."
In my 25 years of teaching, I was never castigated or threatened so bitterly for " suggesting that there might be something wrong with the child," and "opening up the school to the risk of a lawsuit." I've longed to offer this bit of grandmotherly advice to parents of struggling students since this episode, but I have a few years until retirement left and I need the money.
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@JaneK Don't you think it would be appropriate to refer this child for psychological and intellectual assessment?
You have a school psychologist on staff.
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Academic failure, by the time one reaches high school is often due to one or more of these factors: Poor nutrition (snack food, junk food, fast food is all many seem to eat by age 14); poor attendance issues--no one monitoring when they go to bed, when they get up, parents so busy trying to make ends meet, everyone leaving for work before their high school age child leaves; technology--students watching youtube videos or texting or gaming until late, late at night, then unable to wake up on time or chronically tired. My students have other stresses too: will mom or dad get deported, (a very real worry), or how do I leave school an hour early because I have to pick up younger siblings since mom has to work late? Many have jobs too, and help with the rent. The reality is, for at-risk students, academics are not a priority anymore--the system is skewed against them, they feel they'll never be able to go to college anyway as the debt incurred terrifies them, getting food on the table--whatever kind, and making sure the electric bill is paid, are the REAL priorities, and so on. The reality where the rapidly shrinking middle class and the affluent live is very, very different from the reality my students live in. Relying on pediatricians to help with academics fails to acknowledge the disparities that exist, and being on the wrong end of that disparity is what actually inhibits learning. It's Maslow's Hierarchy all over again. Lack of safety, security = low achievement.
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@Eva Lockhart
Yes, this holistic, bio-psycho-social framework for understanding school performance is far more powerful than the standard medical model that physicians employ.
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@I dont know
Thank you IDK. I wonder how many physicians even know that the bio-psycho-social framework has been validated repeatedly in the 40+ years since it was first introduced.
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@Don Salmon
Any pediatrician (and internist and family med doc) trained in the last at least 2-3 decades is deeply steeped in the bio-psycho-social framework, and it is integral to the histories we take, the physicals we do, and the assessments that result.
Of course, that is different from saying it should be the physician who is in charge of every implication for child and public health that might relate to that.
In reading many of the comments (blame the parents!) a key element of this issue hasn't been addressed - schools have a reason not to do testing well or thoroughly. If a kid tests for dyslexia, by law they must provide dyslexia resources. They have every incentive to slow walk testing and minimize the scope. No screening, wait for the kid to be a year behind. 2 years behind. Blaming the kid for being lazy and letting them washout of school is cheaper than treating the learning disability.
Having the child's pediatrician participate or direct testing is a good start. We sorely need that check and balance in the system.
Remember too that no one is a better advocate for you for your child. The school will not point out problems until the kid is severely behind, leaving you and to play catch up. Getting your kid screened rather than letting him or her fail is critical. And with dyslexia, slow walking help will leave your kid permanently struggling with reading the rest of his or her life. You need to start before age 8 to see the best results, but most kids aren't even diagnosed until 9 or so. We've known how to screen for dyslexia for 20 years, yet still we let kids fail before helping them.
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@Jen
Really? "Remember too that no one is a better advocate for you for your child. The school will not point out problems until the kid is severely behind, leaving you and to play catch up." Your bias is showing. You offer no evidence for this absolutist (and patently absurd) claim. Schools won't point out problems, period? Schools and teachers have many incentives to pursue such problems not least because it takes the scrutiny of the teacher and school. But, more to the point, teachers and schools want to help kids.
Dyslexia is almost certainly over-diagnosed in some communities. Your comment reads like marketing material not sound reasoning. Must start before 8? New Zealand and Finland have historically not even started literacy instruction until kids are 7. What you are advocating--too much, too early--is part of the problem, not the solution.
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@I dont know If you look at the studies, fron what I have read, dyslexic children have a window until about age 8 where you can make substantial progress in their phonetic awareness skills. Miss that, and that kid may struggle with reading their entire adult life.
Brain scans have shown that about 1 in 5 people have some level of dyslexia, yet only the smallest fraction get any treatment. Yet according to you it is over diagnosed.
You did not see how my otherwise bright child struggled to recognize the letters of the alphabet. To remember what sound "sh" makes. Had she not been at a demanding school she would have been passed off for years before utterly failing before getting help.
Symptoms of dyslexia begin early. A 4 year old may not care about rhyming for example, while an unaffected kid loves word play, a sign of reading readiness.
Starting later may weed out some kids who are slow to start, but for the severely impacted like my daughter it would have disastrous. Screening can tell the difference, but our default is let kids fail first.
I will be very interested in seeing the response from rank and file pediatricians. In the current environment, these physicians are tremendously pressured to manage their productivity from insurers. And since 35+% of school kids are on Medicaid, is Medicaid going to be reimbursing for the time spent helping to resolve issues that are non-medical in nature--schoolmate hazing or being in the wrong classroom?
It's not that this thinking isn't wonderful, it just doesn't seem realistic in today's healthcare maze. Dr Welby, are you still there?
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@TigerLilyEye - If the child is struggling in school due to a medical problem, I would hope that the pediatrician would have been the first to notice this and draw attention. But life doesn't always give us a straight line. In the last 5 years, two of my last three internal medicine doctors have up and moved meaning we have to start all over again with the doctor/patient relationship. I can't even tell you my current doctor's name without looking it up. We have seen each other for a whopping 15 minutes and spent a good deal of that time talking about our mutual love of the sci-fi show Farscape.
@TigerLilyEye TEACHERS are the ones who are best suited to help children with educational problems, not doctors.
Would you go to a librarian for help fixing your car? Nope. I'm not sure why doctors are the so-called "experts" on educational problems instead of teachers.
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@Diana HI. I absolutely agree with you. I teach second grade in a low-income district. However, even though we want to help all of our students as much as possible, our workload is truly untenable. We work about 50 hours a week just to keep up with the basics. Our time in class with students is so structured, and so many expectations are put on us, particularly around testing, that even in class we are unable to give students what they need. It's really a horrible situation, and it breaks our hearts to see what needs to be done and not be able to do it.
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When the child of poor parents don't do well in school, the kid is considered to be not all that smart. When the child of Times readers don't do well, it's time to call in the experts for a "complex problem." Maybe your kid simply isn't suited to academic-type study. The only shame in that is parents who won't move on and allow their children to flourish in their own way, as we saw in the college-admissions scandal.
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@HKGuy
You've got it backwards. Every child deserves to be understood in the full complexity of their situation--rich or poor. And judgements about whether kids aren't "suited to academic-type study" shouldn't be made when they are in grade school--by others.
You speciously draw some line from your position to admissions scandals. I prefer to think about all of the late-blooming experts who did not find passion or engagement in academics until later. What about them?
There are lots of things we are not suited from when we are 11 that we are suited for when we are 21.
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As a teacher, I am consistently stunned at how many pediatricians write an Rx for 6-11 year olds based on a checklist I have filled out. I have no doubt that some children benefit from medication but not the number that I see. Students need to move and play and create and get away from screens. As "tech" continues as the wave of the future, student have weaker fine and gross motor skills, a level of detachment and lack of interest in things that are not placed directly in front of them on screens. I try to incorporate building and movement in activities which demand creativity and FAILURE. I think the rise in anxiety for kids has less to do with bullying and more to do with a lack of "normal" stress and development of skills to overcome those stressors.
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@Chantal When teachers like you don't do their job to help children address educational issues, you have no right to complain about parents side stepping you and going to the pediatrician.
Teachers are the experts on education and educational problems, not doctors. Yet many teachers have abdicated their responsibility and simply tell the parent "your child is not doing well, you go figure it out and good luck!"
@Diana Please see my previous comment. Our hands are tied in so many ways, you can't imagine. If you have children, maybe ask their teacher if there is something you can do to help. Volunteer in the classroom? Cut and paste? Help buy supplies? We can only continue to help kids if we all work together.
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@Diana
You are doing Chantal an injustice, and in fairness you should re-read her post. What she is saying is that doctors often prescribe meds for kids based on a written checklist filled out by a teacher, which (I think) she feels is inadequate and might only show a portion of the overall issues. I also think you are overstating the degree to which teachers are the "experts" on educational problems. They know a lot about learning and students, especially if they are experienced. That doesn't mean they necessarily have specific training in various kinds of cognitive, social, or emotional issues. Which might be too bad, but is a reality. Teachers have to deal with a pretty vastly array of issues. Lastly, I am sorry you feel that teachers are abdicating their responsibility, and I suspect you have a particular story that validates your feelings. Still, are you in a position to know anything about Chantal? You seem very quick to judge her actions, yet I think she's talking about something rather different than you are.
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The medical community will no doubt use prescription medicines to "solve" the child's problems. Just what we need, when the "problem" might be caused by several things not related to a "chemical imbalance"--
- The school system has a very narrow definition of "success" and children who are, for example, visual-spacial learners tend to be devalued;
- Standardized testing in the schools act as deadlines for students to learn X material. Students develop at different rates and may not be read to learn X material by testing time, hence the struggle in the classroom
- The parents may be having difficulties at home and the child suffering or they child might have other problems outside of the classroom.
No matter! The doctor can prescribe Ritalin or other heavy drugs to force the child down this particular path.
There's no talk of fixing the school system to, for example, use other testing methods, or to bring back visual arts that might encourage a different-learning child, or to change how students proceed from one grade to the next. It's a factory model where the child gets on the assembly line at age 4.5 and gets stamped at certain dates with certain qualifications and then kerplonks out the other side, ready or not, damaged or not--even the high achievers are damaged. UPenn has had so many suicides. Including its mental health director. Wonder why....
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I still kick myself for not getting my daughter treated for poor articulation earlier. At age 4, I asked a doctor (her regular doctor was out on extended leave) about kiddo's articulation. Doctor, rather flippantly after one visit, said it was fine. I later got her assessed, and developmentally she was in the 3rd percentile. As in yes, 3% on that bell curve. I don't believe the doctor could tell the difference between articulation issues and vocabulary issues. Her vocabulary and grammar was great, she just spoke with a 2 year old's voice.
Had I got her articulation addressed early, it could have helped prevent her dyslexia from being as severe as it is. It solidified in those critical development years. She's not going to be able to spell "dog" if she's not even process that "d" and "g" have different sounds, let along say them correctly. Zero natural phonologic awareness. She had to be explicitly taught the sounds before we could work on learning to read. I have spent years and thousands of dollars getting her reading.
"She sounds fine to me."
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@Jen you did the right thing to insist on evaluation. no one knows better than a parent. remember that pediatricians are not speech language pathologists or therapists. as a general pediatrician myself, I am not trained to diagnose or treat speech or language disorders. what may seem reasonable behavior/language based on one short visit with child may not be normal. bottom line is that what was supposed to have happened, happened - your child got the help she needed. my rule of thumb is when in doubt, evaluate.
7
Parents, pediatricians, teachers, special educators, psychologists now have a very large elephant in the room that increasingly pays a very large role with children who are having school problems - the phone and social media. All too frequently some children and adolescents (and parents) spend untold hours with devices which interferes with homework, development of critical thinking skills, reading fluency and productive social interaction.
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Why is the author ignoring the negative effects a contentious home life can have on a child? Bitter, overstressed and angry adults often (unintentionally) do terrible damage to their offspring that shows up in behavior and poor grades.
Testing the child's development may indicate the problem lies in an adult's inability to manage life's slings and arrows. As parents are frequently deep in denial about trauma at home, discovering the source of the problem demands serious interview skills and the willingness to consider that the disfunction may not be with the student.
24
I wonder if they will ask about nutrition and what kind of help the student is getting at home. At my son's previous school, many kids (including those with the most behavior problems) brought lunches consisting mostly of sugar water, chips, and candy to school every day. A kid that my husband tutored said that he slept on the couch every night and that it was hard for him to sleep because his older siblings stayed up playing video games on that same couch until late every night. He also said no one read with him or looked at his homework. Those conversations are difficult to have, but there's no doubt that they matter.
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@reader Those are problems, but do you think that parent gets their kid to the pediatrician? I think kids with those sorts of home issues only get the ER or urgent care when they are bleeding or in need of an antibiotic.
5
Seeking input from a child's pediatrician is a good idea. In addition to any insights gained, the visit may show your child (and her teachers) that you want to help and are taking this seriously. Also, it can help move the narrative away from words like "lazy" and "stubborn." The last line of this article is by far the most important. All children need an advocate, and parents are in the best position to fulfill that role. When we get our own egos out of the way and focus on the whole child, we are in the best position to help her succeed.
7
I beg to differ here as pediatricians already, n this day of managed care mayhem, already have enough on there plates with the endless record keeping demands. The school is the place to start as they are required to conduct comprehensive evaluations under the law. If a parent feels the school is off base, then parents may request and independent evaluation from and outside agency or practitioner and this cost will be covered. School personnel are equipped to handle most evaluations unless there is a medical or neurodevelopmental concern, then the pediatrician should by all means be consulted but otherwise it's not the place to start.
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@Horseshoe Crab
As a Certified Sp.E. teacher who specialized in severe cases.... I agree with you... Problem was/is not giving the complete comprehensive test such as the WJIV (Woodcock-Johnson IV). Typically only tests 1-10 are administered... where children with challenges really need to ALSO take tests 10-20 to give a more comprehensive and strategic view of their strengths and weaknesses. Even the company says that the validity of the test is questionable unless all 20 are administered.
Secondly, I found, unfortunately, people who administer the test are not properly trained and often receive no training at all, except for having a admin test prep brochure shoved in there hand. Queuing (giving away the correct answer through tone of voice or body gesture) being the most egregious mistake, test givers make.
Thirdly, and perhaps saddest of all, I saw literally hundreds of cases pass through where the ultimate decision from Pediatricians was prescribing drugs... and typically Ritalin or some other form of Amphetamine (Yes folks...Ritalin is SPEED). do you realize what continued long term dosages of a drug like this does to a child's developing brain and body? Well neither does the medical community, because it's considered unethical to test such drugs on minors and so has NEVER done so.
Proper testing and diagnosis is paramount. I've always advocated for independent highly trained and certified 3rd party testing, actual treatment varies with the individual child.
23
All pediatricians are too bogged down with managed care paperwork to address this issue? Are you sure you're not an educator protecting your turf?
3
@Kevin Banker Teachers are experts on education, not doctors. Yet this article makes it seem like doctors are the first and last stop for educational problems.
That's absolutely absurd. Doctor should be the LAST resort after all testing is done thru the school system.
Teachers are being completely bypassed here and it's ridiculous
7
Thank you for the great article. I am currently navigating these waters with my son. We are fortunate enough to be in a school district that seems to have the resources he needs. As explained in the article, it is important for the parent to help build the "team" that will help their child succeed. That includes themselves, teachers, specials, tutors, psychologists, principles, etc., and now their pediatrician. I keep a folder and notes, and send in a friendly email to his primary teachers once a month to check in. Also I check in on my son at his level, to gauge how he is doing and adjust strategy as needed. Don't forget, for much of human history children learned by being out in the world and doing. For all his hard work in the classroom, I try to schedule fun lightly organized time out as well.
15
Ideally pediatricians and schools would work together to address children's needs. But, as in much of the rest of society, different elements rarely communicate with each other. Success in life requires a holistic approach which is not always available and it does come down to parents being aware of this and advocating for their child. They are not however, generally supported by educational or medical systems which are are inflexible and driven by targets and profits.
18
actually we should be helping schools figure this out. is there anything the primary care doctor is not responsible for?
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@GFF this is a great point. as one primary care doc who wrote a book on this pointed out, primary care docs are more like hall pass monitors. we are responsible for every little bit of liability that a school or work place or day care or parent wants to say someone can go back to school/work/daycare or someone is excused for missing a day and so forth. we are charged with filling out 504 forms when we cannot even get learning evaluation results to find out *what* the diagnosis is, etc. we even have to write letters all the time stating that the child should be allowed to use the bathroom when they want because restroom breaks are often very tightly regulated, or that they can wear an open-toed shoe when their foot is swollen from an ankle sprain. Duh - these things seem obvious. yet you need an MD to sign a note stating this. I think this stems from people not knowing each other anymore and society being very litigious. there has to be all this 3rd party certification of any little thing between parent/school or parent/work, and often it involves me, the primary care doc.
5
““Children not proceeding academically are usually not lazy,” she said. “There’s usually a problem underneath it, and it’s usually a complex problem — all children pretty much want to succeed.””
This is the truth! In my job I work with students who need structured phonics instruction and may have dyslexia. Very common from families as we begin our work together is, “She is so lazy about her spelling.” But if children can, they will, because we all want to succeed. As their spelling skills improve and the barrier to their success is removed, their performance changes.
There are lots of ways to teach the various academic skills, and sometimes a person needs to learn in a different way than the one that works well for the majority. There’s really nothing wrong with this, is there?
Dr. Ross Green talks about barriers to success vs “laziness”, too. He’s very accessible and has refined my views on these ideas as an educator, and I recommend his videos to teachers and families.
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@BCBC My daughter is severely dyslexic. She has to work harder than most kids to to keep up. We're getting her the help she needs, but she knows she's different.
I was chatting with her teacher, who while helpful isn't quite as knowledgeable about dyslexia as I am at this point. She was emphasizing how to teach kids to understand context in what they read, and how important that is. She completely missed that it is one of they key areas that dyslexics are naturally gifted at - understanding the big picture, applying knowledge, making connections. Having her focus on context aspect, rather than structure reading with a phonological emphasis, isn't going to help her improve.
Dyslexic kids are born knowing how to think, while most kids need to taught. Being a natural big picture thinker comes at the expense of phonological awareness and the ability to learn to read fluently. Dyslexia is surprisingly common in our best and brightest, all who did terrible at school. Our school system has a lot of trouble recognizing what dyslexics (1 in 5 kids) do well.
Will look up Dr Ross Green.
6