School problems and the Family Physician:1
Dr. Latha Ravichandran, DCH, DNB(Pediatric

Medicine)

Introduction:
School learning problems are present in 12-26% of the school children. Children with school problems are constant

trouble to teachers and parents, and a great challenge to the Family Physicians. The reasons for school problems in children are multifaceted necessitating a multi-disciplinary team approach for their management while this team should ideally include

a Family Physician, a psychologist, the class teacher, a special educator, school administrator, a school counselor, social worker and other specialists; a somewhat comparable system works through the school health programme in India.
Role of Family Physicians
The primary role of Family Physicians in helping children with school problems is by obtaining the medical, social, and family history and performing a complete physical assessment of the child to identify and exclude medical causes for school problems.
Common school problems
Learning disabilities: These are characterized by difficulties in listening, speaking, writing, reasoning or computing that are presumed to stem from some brain or central nervous system dysfunction.
Emotional and behaviour disorders: These are problems that can range from minor disturbances to the dramatic symptoms displayed by children with oppositional defiant or conduct disorders.
Mental retardation : It is characterized by significant cognitive impairment in intellectual functioning and adaptive life skills. Mental retardation is diagnosed in people with significantly below average intellectual functioning and related limitations in two or more of the following adaptive skill areas:

• Communication

• Home living

• Self care

• Social skills

• Community use

• Self direction

• Health and safety awareness

• Functional academics, and

• Leisure and work skills

Chronic illness and physical disabilities: Chronic illness that affects the learning of the children include irreversible and permanent medical conditions such as brain injury, autism, convulsive disorder and cerebral palsy as well as chronic conditions such as asthma, allergies, Type I diabetes mellitus, repeated otitis media, thyroid disorders etc. that can interfere with their learning. Physical abilities including visual and hearing impairments or orthopedic problems also affect learning.
The role of Family Physician is to help the child to stay as healthy as possible and to explain to the school staff how this condition and its medication may affect learning.
Attention - deficit/ hyperactivity disorder (ADHD): ADHD is characterized by developmentally inappropriate degrees of inattention and impulsiveness with or without hyperactivity. Diagnosis of ADHD includes impulsive behaviour that is present before the age of 7 with symptoms observed for at least 6 months and in at least 2 settings.