School Problem Red Flags

How do I know if my child's school struggles are significant?

The school year is half over and most parents have had at least one teacher-parent conference. Some meetings resulted in parents being concerned, yet unsure of what to do, wondering if they should just observe their child, visit with their pediatrician or just go straight to a therapist.

How do you know what to do? When is a problem a problem?

The following are guidelines for either concern or the need to watch your child’s progress over time. They could also indicate a red flag that needs attention.

For too many years, the wait-and-let-them-mature approach ruled most of the early childhood issues, but that has changed. Previous advice from grandparents to pediatricians and educators was, “Oh give him a year, he’s just immature,” or “He is a boy,” or “It’s a phase and she will outgrow it.” We now know that if we wait, the same concerns are present or may have worsened, and opportunities to help have slipped past. Research has shown that delay isn’t the wise course; rather a full assessment of behavior and learning problems is warranted. Too often, I see parents whose child has had only the most pressing issue addressed, but a full assessment would have revealed other problems that also needed early intervention.

First, let’s separate the behavioral from the learning issues. When most parents hear the words “school problems,” the first thought is that the child is having trouble with learning, but really the most common issues in the early childhood classroom are behavioral/social. After all, children are on their own for the first time and experiencing life on all fronts. Everyone’s expectations are enhanced and the common present-day hope is for a wonderful learning experience to prep the child for an Ivy League college and bright professional future. The reality is that navigating these social, behavioral and academic challenges all at once, and without parents’ coaching, is sometimes daunting for young children. Failures are both expected and necessary steps for the child to learn.

It is not the failures, however, that are a problem, but how the child responds or reacts to these frustrations that tells the story that we are interested in and reveals the possible red flags that need to be addressed.

At the first sign of struggles, everyone wants the comfort of a diagnosis – a label to understand and treat. ADHD comes to mind as the diagnosis given to many children, but in actuality ADHD only affects 7 percent of children. In OU-Tulsa’s research studying all pre-K students in Broken Arrow, we found that almost 40 percent had some degree of an at-risk issue that could be strengthened by interventions that would give those children a better chance to succeed in school and, most importantly, in life.

Our research has shown that in children under 10 years of age  may exhibit problematic symptoms and, without early intervention, may be diagnosed in their teens. With proper help, we have time to prevent a diagnosis from becoming a reality.

So, what are the symptoms we are looking for?

We have learned that behavioral/social skills affect learning, and a child needs a competency with these skills to have maximal learning potential. Learning also affects the behavioral/social problem-solving, but that takes a backseat in the first few school years. Teachers seem to recognize this intuitively, so those issues that cause disruption within the classroom get prime attention and are the most common concerns imparted to parents at the first parent-teacher conferences.

What are the wait-and-see concerns? Not all early learning behaviors are red flags or even cause for alarm. First, fine motor skills such as cutting with scissors, coloring within the lines, etc., are developmental skills that can vary widely in early childhood. Parents can practice these skills at home as they spend time with their children, and watch for progression over time. The same is true with gross motor skills such as jumping rope, skipping, etc. Unless a child is severely behind or parents and teachers are noticing something outside the bounds of “normal” development, a wait-and-see approach is warranted.

The next area needs a little history to clarify what may or may not be problematic. Educational/academic expectations have been pushed down over the years, and now a kindergartener is expected to be able to recognize letters, numbers and to perform other academic tasks that used to be introduced or mastered in first grade. Therefore, many preschool and kindergarten children are labeled as “behind” in the eyes of some classrooms, but in reality, those children may actually be developmentally on target. The child may not be the problem; the classroom expectations may be the problem. Be patient, it is improvement over time that counts. One large school district that began a gifted program found that only 38 percent of those that were “gifted” at age 4 were still gifted in fourth grade. Early development is not the same as being gifted. By age 9 or 10, you can truly tell if your child is gifted. Concentrate on who your child is, and not what he or she can produce.

In early childhood, red flags are more often behavioral/social difficulties. Behavioral/social skill weaknesses are:

• Excessive frustration when things don’t go the child’s way.
• Lock-ups/meltdowns that can follow anything that overwhelms the child.
• Difficulty sitting still, taking turns, or waiting; often interrupts.
• Refusal to obey rules.
• Frequent uncontrolled anger, particularly if it leads to fighting.
• Difficulty making friends.
• Trouble with transitions.

These all signify that the child has difficulty solving problems. When a child at age 4 is experiencing difficulties with change/transitions, new experiences and the demands of social rules, that is a predictor of long-term outcomes (success or lack of success throughout school and life) and begs an assessment of the issue. An assessment will allow interventions to begin to immediately help the child to strengthen the skill sets that are weak. This early intervention gives the child an early start to maximize success. Taking a “wait and see” approach by waiting for behavior to improve without intervention merely delays this advantage and lessens a successful outcome of the early school experience.

In addition, unattended behavioral/social issues in young children will continue through later elementary school and beyond, which will affect the child’s ability to do well in school. The difficult early childhood behaviors discussed earlier will begin to manifest themselves in older children as difficulty with impulse control; difficulty paying attention to tasks; difficulty with planning, organizing and time management; difficulty organizing materials, completing and turning in homework; and difficulty monitoring work.

Pay attention to early red flags. If your child is struggling in school with a red flag issue, what should you do? First, trust yourself; if you are uncertain about whether or not your child has issues, you can either ask your doctor to do a screening assessment, or ask the school to have your child tested. Next step, share the results with your primary care physician prior to his referral to a specialist. The last option is to ask your physician to refer you for a private behavior/learning assessment. This information will allow your doctor to refer to the most appropriate specialist to begin early interventions to help your child maximize his successes.

Robert J. Hudson, MD, is a recently retired clinical professor of pediatrics, OU-Tulsa School of Community Medicine, and co-director for the Center for Resilience. His book The Normal but Not So Easy Child will be available in the spring.