SCHOLASTIC BACKWARDNESS

Scholastic performance of a child is the measure of achievement in academic field. Unrecognized and unresolved scholastic backwardness leaves a life-long impact on the future, affecting educational achievements, employment prospects and behavioral performance.

Prevalence of scholastic backwardness in India is uncertain due to poorly defined criteria for diagnosis but estimated to be in the range of ~20-30%, being the common cause of school drop-outs.

Etiology is multi-factorial, ranging from subtle learning disabilities to frank intellectual disability or presence of function-limiting hearing/vision impairment. Environ­mental factors and general health of the child are also major determinants of academic performance (Table 3.16).

TABLE 3.16: Causes of scholastic backwardness

TABLE 3.15: Causes of speech/language delay

• Hearing loss since birth or early infancy

• Central processing defects

- Mental retardation or learning disorders

- Autistic spectrum disorders

- Post-meningitic/encephalitic sequelae

• Phonation organ defects

- Structural: Cleft palate, adenoid hypertrophy

- Neuromuscular: Cerebral palsy, bulbar palsy

- Breathing disorders: Chronic lung diseases

• Environmental factors

- Speech problems in parents

- Emotional deprivation

- Bi-lingualism

Primary (organic)

• Intellectual disability

• Learning disorders (dyslexia)

• Attention-deficit hyperactivity disorder

• Visual or hearing impairment

• Systemic: CNS disorders, hypothyroidism

• Drugs: Anticonvulsants, substance abuse

• Toxins: Lead or aluminium poisoning

Secondary (environmental)

• Family: Lack of encouragement, stress

• School: Inappropriate teaching methods poor student­teacher relationship

• Emotional, e.g. frequent school changes

• Behavioral disorders

• Frequent school absenteeism

• Chronic diseases, e.g. asthma, epilepsy

Assessment: While scholastic performance is objectively reflected in the examination results, school teachers and parents are in best position to identify early warning signs of scholastic difficulties, e.g.:

a.

b. Reluctance to volunteer for reading/writing activities in the class,

c. Tendency to misread/misinterpret information,

d. Difficulties in reading, writing, spelling, mathematical calculations, etc. and

e. Development of behavioral problems, e.g. frustration, aggression, defiance, etc.

A child struggling with scholastic backwardness needs early identification and comprehensive evaluation including: (a) assessment for vision and hearing, (b) general intelligence testing (IQ), (c) formal testing for learning disabilities (Ch 3.7) and (d) search for environmental factors, e.g. socioeconomic and emotional reasons, which are preventing them from achieving their full potential.

Scholastically challenged children with normal IQ scores usually have learning disabilities, while those with IQ ranging from 70-89 are considered as slow-learners. Those with lower IQ scores (lt;70) are likely to have intellectual disability.

Management depends on the identified cause, with non-pharmacotherapeutic management being the key. All children and families can be benefitted by a well-planned dynamic program using modalities of remedial education, life-skill training, management of comorbidities and provision of appropriate family/ community support. Pharmacotherapy is useful for management of comorbidities. The physician's role as the “conductor of this orchestraquot; of support is vital as part of the journey of each family.

3.11