Washington - The school year is drawing to a close and you probably have a good idea how your child will do.
It's not uncommon for parents to bring a child into the paediatrician's office after a report card to say that “he can't focus and needs to be on medication.” But there are countless causes for poor school performance, and identifying the right problem to fix is the key to success.
Don't wait for a report card to find out your child is having a hard time
When the first indication of a problem is a report card, it suggests that a parent could have been more proactive. Teachers have a whole classroom of kids to worry about, and they get busy. Often they don't contact parents about a child's performance unless the student is struggling greatly. They also don't know how much to expect from a particular student until they get to know him or her.
Fortunately, parents have more opportunities than ever to stay informed about their children's academic progress. Many schools publish grades online, and many teachers are receptive to quick e-mails asking about a child's performance. Waiting weeks for grades to come out can make it harder to pull a bad average up. (And even if your child is doing fine, it's important to stay on top of how things are going.)
Your involvement in your child's education shouldn't stop at the carpool line or bus stop. Get to know the teacher, the school and other parents. Attend class events when parents are invited. Some primary school teachers look for parents to read books to the class. And if you have time to spare, consider volunteering regularly - as a classroom assistant in elementary school or for other roles in the higher grades. It can be a lot of work, but volunteering is a great way to stay connected. It also shows your child that you value his or her education and makes it far more likely that you'll be aware of your child's academic and social situation.
Have realistic expectations
Not every guitar player is a rock star, and not every kid with a soccer ball will make it to the World Cup. Similarly, it's unrealistic to expect every child to make straight As - or even As and Bs. Statistically speaking, somebody has to be below-average. And that's not to say that children who struggle in school won't be successful in life or have lucrative careers; there are a lot of great jobs out there that don't require a degree.
I'm not saying that grades aren't important or that you shouldn't push your child to do her best; I just want to emphasise how crucial it is to figure out exactly what “her best” is. If your child is capable of making straight As but isn't trying hard enough, push her to do better. But if she's working her butt off to make Cs, reward her efforts. She earned it.
When I talk to families about school performance - a routine part of a paediatric well-child visit - I ask about grades, and I follow that question with another one for the child: “Is there anything that would help you to do better?”
I've had kids tell me that they need more time for tests, that they need someone to spend more time explaining maths or that they get distracted by children around them - all of which are issues that schools commonly address. If your child is struggling, ask what would help. It may be something you can do or something you can discuss with the school. Or maybe there's nothing. But it doesn't take long to ask.
Find the problem to fix
Often parents and teachers (and, sadly, doctors) assume that the solution to bad grades is medication. I frequently get such comments from parents as “He isn't paying attention in class and needs ADHD medicine.” What's missing from this logic is a diagnosis - why isn't the child paying attention? Just like fever, “not focusing” is a symptom, and it could be a manifestation of a wide variety of problems:
* I can't focus because I didn't get enough sleep last night.
* I can't focus because I'm scared that people will laugh at me if I say the wrong answer.
* I can't focus because I'm worried that my grades won't be good enough.
* I can't focus because I'm thinking about Mom and Dad fighting last night.
* I can't focus because I'm not being challenged.
* I can't focus because I just don't understand the material.
* I can't focus because we don't have food at home, and I'm hungry.
* I can't focus because the kid sitting behind me keeps whispering that I'm fat.
* I can't focus because I don't learn well in this environment.
* I can't focus because I can't see the board (or hear the teacher).
* I can't focus because I have a seizure every few minutes.
* I can't focus because I want to go get high with my friends.
* I don't focus because I don't think school is important.
* I don't focus because I just don't care.
* And finally, I can't focus because I'm easily distracted.
I'm not making these up; as a doctor I've seen all of them and more. Hopefully you can see that poor school performance doesn't necessarily equate to attention-deficit hyperactivity disorder. Far too often, children get diagnosed with ADHD by doctors who fail to consider or address these other issues. For kids whose primary problem is something besides ADHD, these medications might help a little, but they won't solve the problem.
It's also important to remember that, while medications for ADHD can be very effective, the goals of using them are to allow a child to focus on the material (not to learn it for him) and to help him think before making decisions (not to make good decisions for him). Successful management of ADHD requires some difficult parenting, a school that fosters an effective learning environment and a lot of personal effort on the part of the child. There's no medicine to replace parenting or studying.
Let me be clear: I'm not downplaying ADHD. It's a very real problem, with implications reaching far beyond the classroom. Studies have found that people with untreated ADHD are more likely than others to get speeding tickets, abuse drugs, get pregnant when they weren't planning to, lose a job, suffer accidental injuries, get divorced and go to jail. Identifying and treating ADHD is really, really important. It's just that not everyone who struggles in school has it, and medication isn't always the best answer.
The first step in fixing a problem is to determine what the problem is - and “not focusing” is only a symptom, not a diagnosis. To make this even more complicated, for the majority of children who struggle in school, more than one cause is contributing to their trouble. The biggest issues should be addressed first, but it's important to keep looking for other problems; they may be more obvious after the primary issue fades away.
Get your child the help she actually needs
This could involve obtaining counselling for anxiety, talking to school administrators about bullying, improving sleep habits or discussing with your paediatrician whether a medical condition could be contributing.
You may need to request that the school evaluate your child for learning disabilities or other learning problems. Maybe it would help to find a tutor or have the child spend more time working on homework. Perhaps your child needs glasses. It might help to request special accommodations such as more time for tests, shorter homework assignments or a different seat in the classroom.
Whatever your child's problem is, you can bet that there's a list of solutions totally unique to her. A child's school performance would benefit from good nutrition, adequate exercise, sufficient sleep and a loving home environment. And maybe - just maybe - medication.
Washington Post ·
* Hayes is a resident physician in paediatrics in Greenville, South Carolina. He writes a blog about paediatrics and parenting at chadhayesmd.com.