Why Do Children Not Do Well In School?

This video is a talk by Dr. Madhuri Kulkarni at HELP on 30 June, 11. Topic \"Why Do Children Not Do Well In School\". Dr. Madhuri Kulkarni can be contacted at 9869524283.This is part of the HELP Talk series at HELP, Health Education Library for People, the worlds largest free patient education library www.healthlibrary.com

People tend to make two assumptions when a child does not do well in school. They usually assume that either the child is not smart enough to learn the information or the teacher is not doing his or her job properly.Neither of these assumptions is necessarily correct.There are several reasons why a child may have difficulty learning because he/she is not comfortable being around others.These children are usually loners and are somewhat withdrawn.
Learning is the process of acquiring and retaining knowledge. It is generally noticed that at least 20% of children in a classroom get poor marks, they are ‘scholastically backward’. There are many reasons for children to perform poorly at school. These include medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes.

For over 100 years it has been recognized that seemingly normal children can have impairment of learning to read and write. In 1886, Morgan described a 14-year-old boy who was bright and intelligent, but had great difficulty to read, and termed the condition as ‘congenital word blindness’. However, it was not until 1962 that Kirk first used the term ‘learning disabilities’.

Specific learning disabilities (SpLD) are one of the most common neurobehavioral disorders in children. They constitute an invisible handicap and are important causes of poor school performance. First description of Specific Learning Disability was by Kussmaul in 1877 who described it as some form of ‘Word Blindness’. The term ‘Dyslexia’ was first used in 1887 by Berlin who ascribed the problem to cerebral, not ocular, pathology.

Hinshelwood in 1896 described dyslexia as a ‘peculiar form of word blindness’. He differentiated complete word blindness, alexia, from partial impairment, dyslexia.

Orton’s report of 1925 heralded the modern era of dyslexia concepts. His report is one of the best clinical descriptions of the disorder. He speculated that rather than a cerebral defect as suggested by Hinshelwood, the mechanism responsible for dyslexia was in the form of a dysfunction.

SpLD is a generic term that refers to a heterogeneous group of neurobehavioral disorders manifested by significant unexpected, specific and persistent difficulties in the acquisition and use of efficient reading (dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities despite conventional instruction, intact senses, normal intelligence, proper motivation and adequate socio-cultural opportunity.

The term SpLD does not include children who have learning problems which are primarily the result of visual, hearing, or motor handicaps, subnormal intelligence, emotional disturbance, or socio-cultural disadvantage. Although, still a matter of debate, this exclusionary definition was adopted by the Diagnostic and Statistical Manual of mental disorders (DSM-IV) and the International Classification of Diseases (ICD-10), classification of mental and behavioral disorders.

Three basic types of learning disabilities that are commonly described are as:

1. Dyslexia: The word Dyslexia is derived from the Greek word \"dys” meaning difficult and \"lexia” meaning words or vocabulary. Commonly interpreted as difficulty in reading, dyslexia denotes a language disorders affecting reading, spelling, speaking and listening.

2. Dysgraphia: The term refers to unexpected difficulty in learning to write.

3. Dyscalculia: The term refers to a disorder affecting mathematical reasoning and SpLD refers to a disorder that interferes with one’s ability to store, process or produce information. SpLD are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and are chronic life-long conditions. Impairment may be so subtle that it may go undetected throughout the life. A history of language delay, or of not attending to the sounds of words (trouble playing rhyming games with words, or confusing words that sound alike), along with a family history, are important red flags for dyslexia. Substantial evidence has established that the children with dyslexia have deficits in phonologic awareness. The functional unit of the phonologic module is the ‘phoneme’, defined as the smallest discernible segment of speech; for example, the word \"bat\" consists of three phonemes: /b/ /ae/ /t/ (buh, aah, tuh).

Children with dyslexia have difficulty developing an awareness that words, both written and spoken, can be broken down into smaller units of sound and that; in fact, the letters constituting the printed word represent the sounds heard in the spoken word. Repeated spelling mistakes, untidy or illegible handwriting with poor sequencing, inability to perform simple mathematical calculations correctly are the hallmarks of this Specific learning disability though a lifelong condition it is amenable to remediation and the cornerstone of management of SpLD is remedial education.

Provisions and accommodations in the curriculum help the child cope up in a regular mainstream school. Remedial education should begin early, when the child is in primary school. The management of SpLD in the more time-demanding setting of secondary school is based more on providing provisions rather than remedial education.

Speaker's Bio

Dr. Madhuri Kulkarni

Prof. Madhuri Kulkarni M.D. Ped, D.C.H, PGDJJJJ

Honorary Senior Consultant Pediatrician, Mumbai Port Trust Hospital, Mumbai since Sept. 2010.

Dr. Madhuri Kulkarni superannuated as a Professor and Head, Department of Pediatrics, from
L.T.M. Medical College & L.T.M. General Hospital, Mumbai in 2008. She completed her medical
graduation and post graduation in Pediatrics at Seth G. S. Medical College, Mumbai and began
her teaching career as a lecturer in pediatrics at T.N. Medical College and subsequently worked
as Associate Professor, Professor, Head of Department, and Dean In-charge at L.T.M. Medical
College and General Hospital, Mumbai.

In a career spanning several years, she has delivered many lectures, and presented papers in
both national and international conferences. She has also, published many papers in reputed
scientific journals. Dr. Kulkarni has been a guide to post-graduate students registered for M. D. and
D.N.B. Pediatrics as well as D.C.H. She also has been a member of editorial board and reviewer of
publications such as Indian Pediatrics, Indian Journal of Pediatrics, and Pediatric Clinics of India.

Dr. Kulkarni underwent training in ‘Munich Developmental Testing’ and ‘Vojta’s Kinesiology’
to evaluate infants at risk for developmental disorders. In 1992 she was awarded international
scholarship at Cleveland Clinic Foundation, Cleveland, USA. She is also trained in pediatric
neurology at the Hospital for Sick Children, Toronto, Canada. In 2003 she was awarded the
Fogarty scholarship in pediatric HIV at the New York School of Medicine. In 2006 she completed
the Post Graduate Diploma in Juvenile Justice and Juvenile Jurisprudence, a new course started
at the Uni. of Mumbai. She has been one of the first few medical teachers to start training of
undergraduate students in WHO-UNICEF IMNCI strategy at its inception in India.

At L.T.M.G. Hospital, Dr. Kulkarni started the Early Intervention Clinic for developmentally
subnormal children in 1985, the Pediatric Neurology Clinic in 1992, and the Learning Disability
Clinic in 1996. This multi-disciplinary clinic has been the first clinic in Maharashtra authorized to
certify children with learning disability for availing provisions since its inception.

For the past 15 years Dr. Kulkarni has been a founder trustee of the Child Welfare Trust at Bhuj
and is a consultant Pediatrician attached to the Dhanvantari School for Special Children run by the
Trust. She is also, attached to the CHILDReach School as a Patron.

During her tenure of Chairperson of the \"Growth, Development and Behavioral Pediatrics
chapter of Indian Academy of Pediatrics for the years 2008 and 2009 she initiated the process
of developing training modules on ‘Growth Monitoring’, ’Developmental Delay’, Autism’
and ‘Behavioural Problems’.

Dr. Kulkarni was awarded \"Top Ten Women of The City’ award by the Junior Chamber
International-India Zone XI Mumbai in 2009.

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