During the past half century, traditional concepts and approaches to the management of comprehensive healthcare for children have been significantly modified. A broader spectrum of psychobiological, educational and psychosocial issues had been added to the roster of "patient needs". The primary care physician has been mandated increasing responsibilities in the management of a myriad of developmental-behavioral problems, in particular, children recognized as performing poorly in school. To address this challenge the physician requires expanded expertise in prevention, early identification, management strategies, and child advocacy.  Dramatic modifications in pediatric priorities (and attitudes) regarding developmental disabilities and behavioral disorders, especially learning disabilities, are the result of: (1) federal legislation (PL94-142) which protects the rights of all handicapped children (2) the successful lobbying and influences of parent advocacy group (3) popularizing developmental and behavioral issues by the communications media, and (4) a renewed commitment by professionals who serve the comprehensive needs of children. Within the framework of this expanded focus on pediatric healthcare, new issues arise regarding managed care reimbursements for serving children in educational jeopardy.

Unresolved learning disabilities, similar to other developmental problems, may be perceived as a chronic handicapping condition with recognized sequelae: (1) the quality of the child's life is in jeopardy (2) potentials for adult productivity are compromised (3) there is an increased occurrence of secondary behavioral sequelae (4) special education resources are usually necessary to assist in the child's academic progress, and (5) early identification and therapy interventions serve to lessen the impact of the disability. It is safe to note that "the earlier the diagnosis, the better the prognosis".

Learning Impairment is one of the most frequently encountered disorders which threaten the quality of a child's life.  Similarly, there are adverse implications that significantly impact on the family, educational system, physician and community. The mandates of PL94-142 (1975) have directly and indirectly contributed to generating new concerns and responsibilities for pediatric primary healthcare providers, in providing early recognition of learning problems.

The child who does not achieve his or her potential is often manifested as the child with compromised academic performances and poor self-esteem. The end result is a cyclic problem of educational jeopardy, which is often characterized by life-long impairments in psychosocial development, i.e., opportunities for a meaningful educational experience are at risk; and prospects for normal social and emotional development are similarly threatened. Causes of compromised human potential are varied, stemming from combinations of intellectual, emotional, perceptual, and learning difficulties. In essence, educational jeopardy generates a myriad of potential psychosocial disorders; involving social maladjustment, confused family relationships, distortions of self-concept, peer isolation, failure to achieve full intellectual potential. The problem is obviously multifaceted and generally requires an interdisciplinary effort in order to achieve meaningful success in habilitative services.

Disorders Of Learning represents a heterogeneous group of problems; reflecting a spectrum of etiological origins. The manifestations include significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. Interdisciplinary diagnostic and therapeutic interventions are generally required for the child with school failure, in order to design meaningful management strategies. The physician has a significant role in this team effort and is often called upon to judiciously select and/or coordinate the multidisciplinary team.  The unique expertise of the pediatrician in neurodevelopmental medicine is critical in resolving the complex differential diagnosis of the child with "troubles in school". Although physicians are usually not professionally trained to write the educational prescription, medical input is often critical in the effective formulation of a child's special educational program.

Therefore, in order to meaningfully contributed to interdisciplinary interactions, physicians must have a working familiarity with causes, manifestations and acceptable therapies for children with learning handicaps. The ability to effectively communicate with a variety of professionals (e.g., speech pathologist, psychologist, special educator, etc.), and to understand and appreciate the range of diagnostic testing is necessary in providing a quality comprehensive pediatric service.

It is generally recognized that the primary care physician has a significant and somewhat unique role in the diagnosis and management of developmental issues. The most important contributions of the physician for children with educational handicaps include:

1. early detection and screening of developmental-behavioral progress
2. assist in the resolution of medical causes in the complex differential diagnosis of "learning-impaired"
3. treatment of acute and chronic illnesses and its possible impact on learning skills
4. judicious use of psychostimulants and other medications to improve behavior, attention and other impediments of learning
5. coordination and monitoring of diagnostic and therapeutic programs, including pediatric reevaluations
6. counseling the child and family as it is related to educational issues. A knowledge of high risk precursors to learning disabilities and a high index of suspicion for the educationally-impaired child should be a component of comprehensive medical care. Many of these efforts should be focused on the PRESCHOOL CHILD, in order to prevent difficulties from becoming major problems which interfere with elementary educational programs.

   Comprehensive pediatric care requires an active medical interest in all parameters of the child's development.  The physician is usually the first professional to assess the child's neuro-motor, language and personal-social skills.  He or she is in the unique position of providing early identification of developmental delays or disorders, which may herald impending disturbances in the learning process.  Similarly, the family physician or pediatrician is usually the first to be consulted by parents and/or teachers regarding the child's academic underachievement and/or associated behavioral difficulties.  At one time, the physician's responsibility appeared to be limited to defining the presence of organic or emotional disorders which might interfere with academic progress.  Medical involvement, however, has been expanded to include the administration of screening inventories and tests designed to assess academic readiness.  The contribution of the physician is directly proportional to their  (1) level of concern,  (2) awareness of high risk factors,  (3) familiarity with types of learning disabilities, and  (4) knowledge of supportive community resources.

   It is important to stress that a spectrum of psychobiological hazards can disrupt the learning process and thereby significantly impair academic progress. As noted, the "bottom line" concern is the ultimate impact on psychosocial development. Behavioral disturbance, secondary to educational stresses, anxieties and threat to a positive self-esteem, often accompany poor school performance. In turn, behavioral sequelae can create a vicious cycle and further impede the child's educational progress. Regardless of the cause of educational jeopardy, the final common pathway is generally an erosion of the child or adolescent's SELF-ESTEEM (self-concept, self-confidence). The combination of poor academic progress and poor self-esteem are ultimately reflected in poor social adaptation and loss of adult productivity. In essence, residues of antecedent learning difficulties may eventually be measured in a compromised quality of life.

   For the pediatrician, EDUCATIONAL JEOPARDY - POOR SELF-CONCEPT - COMPROMISED QUALITY OF LIFE is a developmental-behavioral "syndrome" of major significance. The recognition of factors creating and contributing to this complex disorder, early interdisciplinary diagnosis and the design of effective management strategies (ideally during the preschool period), are the challenges in preventing educational jeopardy and its profound, often irreversible, sequelae.

   
   

   Related Childrens' topics:
   Television Viewing: Impact On Child/Adolescent Development
   Gifted Children: Blessed or Handicapped?
   Latchkey Children: "Something To Think About"
   Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE)
         (Development-Behavioral Considerations)
   The Child In Educational Jeopardy
         (A Pediatrician's Perspective)
   Head Trauma: After Acute Care, Then What?
         (The Developmental-Behavioral Pediatrician's Perspective)
   Chronic Otitis Media - Speech/Language Disorders
         Learning Disabilities: Is There A Link?

   
   

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