SCHOOL
FAILURE
Kurt Glaser, M.D., and Raymond L. Clemmens, M.D.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
(Submitted April 13; revision accepted for publication September 10, 1964.)
Presented in part at the Thirty-second Annual Meeting of the American Academy of Pediatrics, Chicago, Illinois, October 8 and 9, 1963.
Dr. Glaser is Clinical Director, Rosewood State Hospital, Owings Mills, Maryland, and Dr. Clemmens
is Director, Central Evaluation Clinic for Children, University Hospital, Baltimore, Maryland.
PRESENT ADDRESS: (KG.), 6114 Biltmore Avenue, Baltimore, Maryland 21215.
SPECIAL
ARTICLE
128
PEDIATRICS, January 1965
T
HIS PAPER will concern itself with schoolfailure in its broadest sense: academic
failure or underachievement in one or more
subjects, with or without retention in the
grade.
Most parents expect the pediatrician to
counsel them in all phases of the child’s
development, including social and
psy-cllOlogical adjustment and educational
mat-tems. Early recognition and identification of
problems interfering with the child’s
sue-cessful schoOl career are essential for the
success of corrective 2
While the educator, psychologist, or
so-cial worker will recognize the existence of
learning problems in the child, the
pedi-atrician is frequently called upon to
deter-mine whether the disturbing factors are
causatively related, unrelated and
non-contributory, or themselves the result of
the educational handicap and/or
second-arily contributory.
In his attempt to grossly assess the
emo-tional and intellectual functioning of the
cilild, the pediatrician can avail himself of
a number of abbreviated psychological
34, 5 Korsch et a!. have shown that
pediatricians’ appraisals of children’s I.Q.
correlate vell VitIl the results of standard
psychological tests, except in the physically
ill child, who was underestimated, and the
retarded child, who was overrated.6 It must
be kept in mind, however, that these are
screening devices and to be used only as
such. Accurate assessment should be
re-femred to the experienced psychologist using
standardized tests.
A
screening test for the determination ofreading levels has been devised by the
Baltimore County Public School System
and is well applicable for physicians’ office
use (see Appendix).
Causes of underachievement and failure
in school are discussed in the following
pages.
LEARNING DIFFICULTIES AND
MATURATIONAL FACTORS
Problems in both academic achievement
and school adjustment are far more
corn-rnon in boys than in girls. It is commonly
held that social pressures and child-rearing
practices centering about the role of the
male in our society are the primary
causative factors for this predominance in
boys.
However, as Bentzen has pointed out,
organic factors may play at least an equally
important role.7 The human male organism
matures at a slower rate than the female.
Thus she advances the hypothesis that some
of the behavior disorders and learning
prob-lems among boys may be the result of the
stress response of an immature organism to
the demands of a society which fails to
make appropriate provision for this
biologi-cal age differential.
While direct methods of measuring
ma-turational rates of the central nervous sys-tern are lacking, other organ systems, such
as the secondary ossification centers, show
consistently earlier maturation in girls than
LEARNING DIFFICULTIES AND
PHYSICAL FACTORS
The importance of detecting possible
physical handicaps in a child with learning
difficulties must not be underestimated. For
instance, tile correction of sensory deficits
may be all that is needed to ameliorate the
learning difficulty and restore
self-con-fidence. However, the psychological
pat-temns resulting from the handicap may be
sufficiently ingrained to need specific
assist-ance. On the other hand, learning
diffi-culties and physical and psychological
prob-lems may not be causally related and each
may need treatment in its own right.
It is not always easy for a teacher to
me-late inappropriate behavior in school to the
presence of a physical defect. Lack of
in-terest, daydreaming, underachievement,
withdrawal-often interpreted as “laziness”
-may be the results of visual or hearing
defects, of anemia, glandular disturbances,
or many other causes. However, in the
mid-die and upper socioeconomic groups such
conditions are usually discovered earlier
and rarely represent signifcant contributing
factors to learning difficulties. Fatigue and
hunger can be found as a result of poor
living habits and inadequate supervision
in the child of well-to-do parents, whose
permissiveness and lack of organization
al-lows or even encourages the child to stay
up late at night or run to school without
breakfast.
The cause of a learning problem may be
difficult to pinpoint; for instance, mental
retardation and deafness may be confused,
or deafness may not be recognized in a
mentally retarded child.8
Neurological disorders in the form of
manifest brain damage, resulting in mental
retardation, cerebral palsy, or seizures, are
usually recognized without difficulty. These
may be associated with psychological
dis-turbances.9 But the realization that
be-havior, language, and learning problems
can be caused by minimal central nervous
system disorders in the absence of overt
evidence of mental retardation or
neuro-motor impairment has come about only
gradually in the recent past, and the
sub-ject still remains controversial.
Two categories of central nervous system
problems need to be examined : first, the
group with neurological damage or cellular
destruction as a result of some insult to the
brain; secondly, the group with
develop-mental or maturational deviation which
me-suits in marked unevenness of functioning
and which is thought to be constitutionally
determined and of genetic origin.
Minimal Brain Damage
Various terms have been used to
desig-nate this group of conditions, such as
or-ganic brain disordems,b0 brain damage,
minimal cerebral 2 hyperkinetic
impulse disomder,13 and minimal chronic
brain syndromes.14
Much of the current interest in this area
can be attributed to the contributions of
Goldsteinl3 and the more recent work of
Strauss and his associates who pioneered
in the educational habilitation of atypical
children.16 They called attention to a group
Of problem youngsters who demonstrated
hyperkinesis, motor inco-ordination,
dis-tractibility, perseveration, learning
disor-ders, and perceptual problems. These
chil-dren were temperamentally unstable,
ex-hibited little capacity to tolerate
environ-mental stress, and had marked difficulty in
adjusting to and achieving in a regular
classroom setting. Strauss believed that tileir
disturbed function resulted primarily from
organic neurological impairment. He
differ-entiated the syndrome from disorders of
psycho-social origin and called them
“brain-injured children.”
Pasamanick et 718 and 92
subsequently demonstrated that theme is a
high correlation between certain pregnancy
and perinatal complications, particularly
prematurity, and learning disorders as well
as behavior problems. Drillien states that
“obstetrical hazards may lower the child’s
resistance to adverse factors in the
post-natal environment.”#{176}
sent a picture of generalized motor
awk-wardness, principally manifest in fine motor
inco-ordination, difficulties in balance,
dys-diadochokinesis, hyperreflexia, mild
choreo-athetosis, and poor handwriting. These
mini-mal signs may go undetected in the
classi-cal neurological examination, but may be
noted in tile expanded neurological exam-ination and ill psychological testing.2’ The electroencephalogram may be abnormal.
Speech and language problems are common
and further testing may reveal problems in
auditory comprehension, reduced auditory
memory, and diminished auditory
discrim-ination and perception.
The restlessness, impulsivity, and
explo-sive nature of their responses make it
diffi-cult for these children to adjust in ordinary
classroom settings. The child’s behavior and
low achievement rate are a source of
annoy-ance to teachers. Psychological disturbances
may develop and may present the major
problem in later years.
In some instances drug therapy may be
of value in decreasing the hyperactivity,
distractibility, and extreme anxieties associ-ated with tile syndrome. Numerous
pharma-cologic agents have been used and
encour-aging results have been 2223, 24
al-though the opinions are far from unanimous.
If secondary emotional factors can be
avoided, the long-term outlook of the
hy-perkmnetic child with adequate intellectual
endowment is favorable. As he matures, the
child often develops the ability to
compen-sate for his perceptual distortions. In most
children, hyperactivity and impulsivity can
be expected to show significant resolution
near puberty, with or without medication.
Once the child’s organic difficulties have
been recognized, adjustment problems can
be better understood. The nature of the
psychological difficulty will vary depending
upon many factors, including family
sta-bility and other social relationships.
Percep-tual difficulties may cause problems in all
areas of learning; motor awkwardness can
make it difficult for the child to participate
in sports and other peer activities.
The diagnosis of minimal brain damage,
and subsequent reappraisal and
manage-ment of the child’s problems, will often
bring about a significant improvement in
the child’s performance, adjustment, and
acceptance. A simple explanation of the
clinical diagnosis, the symptoms, and the
prognosis may help parents and teachers in
their attitude and approach, and this in turn
may help these children in coping with the
environmental stresses at home, at play, and
in school.
A significant number of seemingly
organ-ically impaired children can be managed by
a combination of direct parent counseling,
psychotropic drugs, structured environ-ment, firm discipline, and educational
pro-23 24 Some of these children present
a generalized picture of immaturity to
vIlich the mother often responds
instinc-tively with overprotectiveness. Within
cer-tam limits, this may be helpful to the child
rather than detrimental. In cases where a
weakness in the capacity of the parents to
respond appropriately to the child’s needs
is the most important limiting factor, more
formal psychotherapeutic intervention is
required.
Specific Language Disability
The acquisition of language skills,
par-ticularly reading, serves as the pass key to academic progress. Children who encounter persistent difficulties in learning to read are
high-risk candidates for problems in
aca-demic achievement and school adjustment. Many investigators have tended to the
view that there is an identifiable group of
children with language and learning
dis-orders due to neurological dysfunction,
\vilich may be determined genetically. This
condition has been described under such
terms as specific dyslexia,?5 congenital word
blindness,26 specific developmental
dys-lexia,27 and strephosymbolia.28
The central issue of this thesis is that
there exists within the community of slow
learners, a specific group which has
par-ticular difficulty in learning the
conven-tional meaning of symbols, which is of
SPECIAL ARTICLE
and is often genetically determined. The
condition is much more common in boys
than in girls, and is frequently associated
with mixed laterality, delayed
determina-tion of handedness, motor awkwardness,
and directionality confusion. Detailed
fam-ily history frequently reveals a similar
read-ing, speech, or language disorder among
near relatives.
The acceptance of this entity is not
uni-versal. Those who are opposed to the
con-cept of specific language disability point
out that retarded readers constitute a
con-tinuum and that it is meaningless to single
out a group of special cases. They believe
that poor teaching, irregular school
attend-ance, social and cultural factors, and
emo-tional disorders rather than inheritance are
the causative factors. They also indicate
that an entity such as specific language
dis-ability or congenital language disorder
might suggest to the teacher that the child’s
problem could not be remedied. Such an
assumption is, of course, incorrect.
An exact definition of specific language
disability is not possible since it ranges in
degree from very mild to extremely severe.
The key point, however, is that reading and
other language skills are definitely out of
keeping with over-all intellectual capacities
and that this difference persists in spite of
competent instruction over adequate
pen-ods of time with pedagogic methods which
are successful in the majority of children.
It is of more than mere academic interest
to determine if learning disabilities might
be of genetic origin. If such an hypothesis
could be established, much of the
long-term frustration and failure resulting in
secondary emotional complications could
be alleviated by early identification,
spe-cial instruction, and appropriate parent
counseling.
An exhaustive epidemiologic study of
reading disabilities has been reported by
Hallgren.2 He studied 276 cases of
read-ing disability and their near relatives, as
well as 212 controls. He found reading
dis-abilities in 88% of the families of his index
cases and concluded that reading problems
are genetically determined and follow an
autosomal dominant mode of inheritance.
Valuable information in understanding
the contributing role of hereditary and
en-vinonmental factors may be gleaned from
studies of twins with reading problems.
Hemmann reported studies on 45 sets of
twins, in which at least one was found to
have a reading 29 Of 3 pairs of
non-identical twins, one of whom had reading
retardation, 33% of the co-twins were
simi-larly involved. Of 12 sets of identical twins,
however, 100% concordance was found.
Al-though the numbers are small, the findings
are of considerable interest and lend
sup-port to the hypothesis that genetic factors
may be involved.
Out of our study and experience0 we
have arrived at the following observations:
1. There exists a group of children of
adequate intelligence and apparently
ade-quate motivation who are seriously
me-tarded in reading and whose problem
can-not be readily accounted for on the basis
of demonstrable physical abnormalities,
emotional disorders, or environmental
fac-tors.
2. These problems are commonly
associ-ated with a family history of reading
dis-ability and language disorder in near rela-tives.
3. Reading problems are more common
in males than in females by a ratio of
be-tween four and eight to one.
4. There is no higher incidence of visual
refractive error among children with
read-ing problems than among children without
these problems.
5. Specific neurological signs are
uncom-mon in children with reading retardation.
However, they frequently are very
awk-wand in their body movements, especially
those involving fine motor co-ordination,
balance, and handwriting.
6. Psychological testing may show a wide
disparity between verbal and performance
scores on the WISC (Wechsler Intelligence
Scale for Children) and this disparity may
he in either direction.
7.
Psychological studies may revealprob-lems in spatial orientation and directional-ity. These children have unusual difficulty
in reproducing and synthesizing geometric
designs and show frank reversals and
rota-tions.
8. Speech problems and language
dis-orders are more common in children with
reading problems than among control
groups. These children have problems in
more than one area. They may be seen by a
psychiatrist and receive a psychiatric
diag-nosis; when studied by an educator, they
will be labeled with an educational
diag-nosis; and when seen by a neurologist, will
be given an additional label. The necessity
of close communication among these
disci-plines is obvious, but these professional
workers have often failed to cultivate
inter-professional communications and exchanges
of ideas necessary for the development of
optimal understanding of these complex
problems 24
The pediatrician, through early
recogni-tion of language difficulties, especially if
the history reveals a familial incidence, can
do much to encourage early remedial steps
and avoid handicapping personality and
school problems.3#{176}
LEARNING DIFFICULTIES
AND INTELLIGENCE
As with any laboratory test, I.Q. test
re-suits must be regarded with caution and in
the proper perspective. I.Q. tests were
standardized on the average American with
an average environmental and educational
background. While its purpose is to
meas-ure intellectual endowment it really
re-fleets the individual’s current functioning,
and the results are the product of
endow-ment, past learning experience, and current
motivation.
A child who has not had the average
in-tellectual stimulation and has not been
ex-posed to learning experiences usually
ex-pected for his age is apt to function below
the highly stimulated child who has been
SCHOOL FAILURE
exposed intensively to learning material.
Thus test results can be misleading as to
actual intellectual ability and future
p0-tential.
Since intellectual ability as measured by
I.Q. tests is relative to preconceived
stand-ards, its implication for a particular child
and his family, and for the child’s ability
to adapt adequately to the demands of his
society must be evaluated from a relative
vantage point and not in isolation. A child
vith an I.Q. of 100, coming from an
in-tellectually superior family, may be
con-sidered relatively retarded by his family
and peers. Unrealistic academic
expecta-tions and pressures on the part of parents
will be in conflict with the child’s ability,
leading to disappointment and defeatism.
The school personnel may or may not
rein-force the conflict by such statements as, “he
is average-just like all the other children,”
the parents wishfully interpreting this to
mean “like his siblings and some children.”
Conversely, relative brightness may stand
out if the child is born into an intellectually
dull family. In such an environment he may
not only suffer from undenstimulation but
may be actively discouraged in his
intellec-tual endeavors which may be embarrassing
and incomprehensible to the parents.
LEARNING DIFFICULTIES AND
PSYCHOSOCIAL FACTORS
Motivation and Stimulation
Basic to a positive learning experience
are eagerness to learn, incentive from the
environment, and exposure to learning
ma-terial.
Underprivileged minority groups often
view with suspicion and resentment the
educated person who has attained a higher
socioeconomic and educational status and
whom they meet in authority roles (teacher,
policeman, social worker, etc.). They equate
education with authority, which produces a
negative attitude toward learning in
par-ents and older children, and this is readily
transmitted to the child entering school. In
such a milieu it becomes undesirable
133
the academically successful child soon
earns the reputation of “apple polisher” and
“sissy,” and his positive educational desire is seen as non-conforming within the group
and unacceptable to peers.
Parallel with this lack of motivation often
goes absence of readily available books,
magazines, and newspapers, and a lack of
active stimulation and participation by the
parents. Pleasurable learning experiences,
such as trips to the library or museum
ex-hibits, are limited, language development is
constricted, and intellectual and academic
activities, if any, are passive and minimal.
While this does not necessarily hold to all
low socioeconomic minority groups, it is
found there much more frequently.31 32
In any therapeutic approach it must be
kept in mind that the foregoing is
essen-tially a social problem which must be
at-tacked by “feeding the hungry, educating
the ignorant, treating the emotionally
dis-turbed”-in that order. Economic
assist-ance, retraining of the breadwinner,
reloca-tion of the family may be the basic steps.
In addition, early educational experiences
to counteract the effects of deprivation are
being attempted through the establishment
of nursery school classes in the public
school systems in underprivileged areas.#{176}
Adjustment of the school curriculum to
meet the special needs of children in such
areas is another way to increase their
moti-vation to learn and remain in school. This
should not mean a deprived curriculum for
the deprived child, but a meaningful
cur-niculum geared to the practical need for
early tangible returns : early introduction of
vocational skills, with academic teaching as
meaningful adjunct to vocational training.
A psychotherapeutic approach is usually
not indicated in this group since their
prob-lem is not one of adjustment difficulties.
They are adjusted to their environment,
and a change of the environment is a
socio-0 The Baltimore city school system started such a pilot study in September, 1962, with funds pro-vided in part by the Ford Foundation under its “Gray Area Program.”
economic problem and basically not a
psychiatric one. In the emotionally
dis-tumbed child who is the product of a
dis-turbed family, treatment has to include the key member(s) of the family.
The mode of living in middle and upper
socioeconomic intellectual groups offers
motivation and stimulation to learning. The
higher educational background of parents
and peers, the high value placed upon
in-tellectual achievement, and the availability
of resources all tend to stimulate the child
to strive toward approval by acquisition of
knowledge and success in school.
Yet this does not always hold true. The
middle- or upper-class girl whose idea of
success is not a successful career or knowl-edge for knowledge’s sake, but a husband
who can provide all material comforts, may
lack the motivation necessary for good
school performance. Her ambivalent
feel-ings about education are often repressed,
but if the conflict can be lifted from the
subconscious level and expressed openly,
clarification and reorientation can occur
and the conffict can be solved.34
In materialistic-hedonistically oriented
families success in school and pursuit of intellectual achievements for the child may
be the expressed desire of the parents, but
their personal example conveys to the child
that father is lacking these attributes and
that his way of life had led him to success
through roads other than those professed
to be desirable. It is easy to see why a child
from such an environment would lack the
necessary motivation for academic success.
The therapeutic approach in these
chit-dren can be frustrating and difficult. At
times interpretation to the parents of how
the child sees them and their life can be an
eye-opener to the parents and lead to better
communication and understanding.
Discus-sions around a realistic appraisal of the
financial situation of the family, often not
as rosy as parents like to pretend in order
to “give the child all the things they have
missed in their youth,” and a review of
their uphill struggle in earlier years can
rein-forced by meaningful limits set with
con-sistency.
Parents often foster social preoccupations
and distractions such as clubs, sororities
and fraternities, and radio and television
sets in tile child’s room. Such competition with study time may be difficult to control
if the child’s school progress becomes
af-fected. Families with such conflicts may
need tactful guidance over longer periods
of time, and parental insigilt into the
coii-flict the’ created may be slow to come.
Negativism
In the process of normal emotional
growth the drive for independence is often
expressed through rebellious behavior,
antagonistic to parental wishes and
expec-tations.’5 What more effective way to
ex-press such feelings than through opposition
to successful schooling, the single most
ex-tensive process of molding youth into the
image of the adult?
This process can take the form of
aggres-sive, disruptive behavior in tile classroom,
defiant refusal to work, truancy or,
con-versely, compliant behavior with passive
resistance to learning. This may be on a
conscious level or, more often, the
resist-ance to learning is subconscious and the
child may sit for hours in front of the book
without absorbing the information, or “know all the work at home” and fail the test in school. Some early school dropouts
fall into this category. The choice of a
ca-reer is often determined by the
subcon-scions drive to assert his independence in
the form of opposition to father’s wishes
rather than by inclination, ability, or even
opportunity.
The child is not aware of the dynamics,
is not responsive to direct interpretation,
and the parents are helpless, and furious
in their helplessness, in the face of
“illogi-cal” behavior. They cannot comprehend
that the child’s actions are guided by
sub-conscious motives rather than by logical,
intellectual considerations.
At times, counseling can change the
par-ents’ pushing, demanding, and punitive
at-titude and can help the youngster to gain enough insigllt into the dynamics of his
ac-tions to enable him to change his course.
Often, however, child-parent antagonism
has become a way of life, has expanded to
antagonism and hostility toward teachers
and any representative of authority, and
cannot be altered by short-term counseling.
This is particularly true when deeper psy-chosexual conflicts are disturbing the
child-parent relationship. Then prolonged
analyt-ically oriented psychotherapeutic efforts will
be necessary, associated with intensive
par-ental counseling or treatment, or even
re-moval of the child from his environment
into an intensive therapeutic setting.36
Inner Conflicts
Inner conflicts can be energy absorbing,
cause insomnia, inability to concentrate,
daydreaming, and can interfere with
ade-quate functioning in learning activities.
Worry about precocious or delayed
sex-ual development, about actual or imaginary
parental rejection, about parental discord,
fear or anguish caused by illness or death
in the family, frustrating competition with
academically superior siblings, to mention
just a few, can seriously affect a youngster’s
physical and emotional well-being and
aca-demic performance.
Deeper probing into the nature of the
conflicts often reveals psychosexual
dis-tunbances in need of correction via
pro-longed therapy. Reading difficulties may be
regarded as a manifestation of anxiety over
inadequately resolved hostile, destructive
sexual fantasies, whereby the patient seeks
relief of the guilt over his hostile fantasies
through self-punishment by exposure to
criticism at home and in school.
Psychoanalysts have pointed out the
analogy between sexual aggressiveness and
looking, reading, and learning. If sexual
aggressiveness is “bad,” so would be
look-ing, reading, and “Repression
of sexual curiosity may block the normal
interest in knowing and thinking. . . . The
‘stupidity’ may represent simultaneously an
parents from whom the patient had
suffered frustrations for his curiosity.”40
A negative conditioning to learning can
be effected early in life through an
un-pleasant experience connected with first reading efforts and their association with a
hated, severe, or punitive teacher on
par-ent.4’
In another study on learning impotence,
the author attributes a negatively charged
pathological attachment to mother as
lead-ing to difficulties in achieving a separate
identity. These children see “non-learning” as a successful form of separation from the mOtller.42
Whatever the underlying cause, it is
im-portant that the emotional conflict leading
to the learning difficulty be recognized and
treated before it produces a pattern of
aca-demic failure with ramifications beyond the
causative factors. Eventually the
complica-ting factors in behavior, grade retardation,
and parental, teachers’, and peers’
reac-tions may hide the original causes.
PROBLEMS OF SCHOOL ATFENDANCE
School Phobia
For the physically ill child, homebound
for a prolonged time, provisions exist in the
school system for help through home
teach-ens, tape recordings, or other technical
an-rangements. Less adequate provisions are
usually available for absences due to
psy-chological causes, often because they are
not well understood. The pediatrician’s role
in this situation involves not only the
evalu-ation and treatment of the child, but
guid-ance for the parents and school personnel.
School phobia, a neurotic behavior
mani-344 may occur with or without
psychophysiologic reactions or personality
disorders. In adolescence, it can be a
mani-festation of a serious character disorder.45
Probably the most frequent cause of early
school phobia is a separation anxiety
mutu-ally shared by mother and child. Maternal
rejection with resulting guilt and
overpro-tection may make separation difficult for
the mother, and this feeling is readily
con-veyed to the child.
Overdependence as a result of
overpro-tection may evoke hostility in the child
to-ward the mother from whom he cannot
de-velop independence. This hostility with
resulting guilt can lead to fear of
abandon-ment,46 fear of death of mother, and a need
for not leaving her side. Childhood
de-pression may also cause school phobia,47
and there are still other causes43 which
cannot be discussed within the frame of
tllis paper.
The therapeutic approach to school
phobia consists of two phases: an
immedi-ate attempt to return the child to school,
usillg verbal pressure, physical assistance,
and environmental maneuvers in order to
avoid secondary effects due to prolonged
absence, such as academic retardation,
shame upon returning, ridicule, etc.
See-ondly, the underlying problem must be
treated. Depending on its depth and
dura-tion, this may in some cases be resolved
quickly or resolve itself, or may require
prolonged psychotherapy for child and
mother.
Truancy
Another cause for absenteeism is truancy,
found usually among the older school
pop-ulation and closely related to delinquency.
This is a deliberate absence from school, on a rational basis, with or without the
knowl-edge of the parents. In many of these
youngsters lack of academic achievement is
a secondary manifestation, although the
lack of intellectual ability or a reading
dis-ability may produce indifference and lack
of motivation for learning, and may be the
forerunners to truancy.
Delinquency
Primary low academic achievement may
lead to delinquent acts as a means of
at-taming recognition and acceptance by
peers, or delinquent behavior as an
adapta-tion to a subcultural mode of living may
lead to refusal-to-learn as part of
group-accepted mores. A vicious cycle often
de-velops which becomes more difficult to
SCHOOL FAILURE
Special sciloOl programs, requiring close
collaboration of staff teams, have been
de-‘eloped to cope with this pmoblem.
In a child whose delinquent behavior is
overtly or covertly supported by his parents
and rewarded by his peers, thus a
socio-logical problem, neither individual
psycho-therapy nor tutoring or remedial reading
can be expected to beam fruit unless they
are part of a corrective process attacking
the social problem.
In many cases of delinquent behavior the
child derives little if any academic benefit
from his physical presence in school, and
is better served by the experience of
me-moval as a result of his behavior, a
conse-quence he is apt to face in later
employ-ment if his conduct is not acceptable.
Training scilool, early employment, special
foster homes, or group homes may be of
more help to this type of ease for his future
adjustment.
In order to prevent such extreme
meas-ures, it is of course important to discover
the potential delinquent as early as possible
and to institute preventive and therapeutic
measures. In some school systems serious
attempts are made to detect children with
potentially disturbed or delinquent
be-havior. Among the programs which have
been in progress for some time are the
Early Identification and Prevention
Pro-gram in New York City49 and the
Chil-dren’s Guild in Baltimore (a nursery school
for emotionally disturbed preschool
chil-dren).
Drop-outs
Closely related to juvenile delinquency
is the problem of the “drop-out,” which in
recent years has assumed such proportions
that it has become of major concern not
only to the educator but also to industry,
labor, and law enforcement on state and
federal levels.
A statistical evaluation of the extent,
causes, and ways toward correction,
na-tionally and by states, was published in a
recent issue of School Life,5#{176} the official
journal of the Office of Education of the
U.S. Department of Health, Education, and
Welfare. It shows that of all ninth graders
in the United States in 1958/9 only 69.7%
graduated from high school four years
later. Table I lists the various causes for
dropping out.
TABLE I
REASONS FOR WITHDRAWAL Civ:x ny PUPILS Wno
DROPPED OUT OF MARYLAND PuBLIC hIGh ScI1ooIs
DURING THE \FAR ENDING JUNE 30, 196110
Reasons Percentage of Total
Lack of interest
Lack of scholastic success Economic reasons r.rarriage Pregnancy Allother
35 .3’53
17Sf I I.1
9.2
5.3 21.3
A recently completed exhaustive study’
points out that the majority of drop-outs
had been retained in some grade at least
one year and were often two or more years
below grade level in reading. But it also
produces evidence that “in a great majority
of cases, lack of mental ability is probably
not the major cause of failure to finish
school.”
Prevention must start before the negative
attitude toward school has become fixed,
and certainly while school attendance is
still legally obligatory. For any such
pro-gram to be effective, close co-operation
be-tween agencies is essential. Schools will
have to adjust their curriculum to be
mean-ingful to youngsters whose immediate goal
is early earning ability and financial
inde-pendence. Teachers need special training
and understanding of the psychology of the
child and his background. Industry will be
called upon to provide training and job
op-portunities, and industry’s needs in turn
must be correlated with vocational
prepana-tion during the school years. Facilities have
to be adjusted to local conditions in the
community, which might change in the
course of years, complicating the task of
long-range co-ordinated planning.
137
to identify at an early age those who seek,
by escape from school, solutions to their
inner conflicts which are often centered
around parental relationships. Many of
these youngsters can be helped by
psychi-atnic intervention, but again early
identifi-cation and early corrective measures are
till
LEARNING DIFFICULTIES AND
EDUCATIONAL FACTORS
One of the most basic approaches toward
the prevention of potential learning
diffi-culties and drop-outs is the adaptation of
the school curriculum to the needs of
youngsters according to their ability,
mo-tivation and orientation, social customs, and
patterns of society.
The basic school program is geared to
the “average” child with an “average”
back-ground, and that is as it should be. Great
strides have been made to provide
school-ing, within the public school systems, for
physically and mentally handicapped
chil-dren. More progressive communities are
providing special educational classes for
brain-injured children, for educable and
trainable retardates, for children with
corn-munication disorders, and for children with
severe reading problems. School facilities
for the emotionally disturbed, for the
eul-turally deprived, for borderline intelligent,
and for the intellectually gifted children
are at this point woefully inadequate.
In low motivational, low socioeconomic
groups and in those with borderline
intelli-genee, which constitute the bulk of failures
and drop-outs, the general academic
cur-riculum is not meaningful or practical since
orientation and economic needs often
de-mand that school experience be translated
into early earning capacity. Postponement
of early gratffication of hedonistic desires
(
dates, car, clothes) in favor of delayed buthigher economic, social, and intellectual
goals is too great a frustration for the
im-mature youngster. The lack of parental
ex-ample and supervision and the desire for
group acceptance through achievement in
non-scholastic activities condition the child
against school. For this group, introduction
of vocational training with tangible goals
and early financial returns must take place
before the child is conditioned against
school and the social structure it represents,
and before he has acquired delinquent
pat-terns of behavior.
The bright child who does not perform
“according to his ability,” the child who
fails when there should be no reason
be-cause “his I.Q. is so high,” or the child who
could do so well “if he would only apply
himself,” is being recognized more and
more as a child who can be helped.
Educa-tors have been making efforts at early
iden-tification of learning difficulties and their
physical or emotional 455 and
diag-nostic services within some school systems
have been established. However, with
in-creasing frequency the pediatrician is
con-suited by the parents, or he may be the first
to recognize the existence of a problem if
he extends his inquiry into the area of
social and academic functioning.
It is estimated that about 2.2% of the
pop-ulation have an I.Q. over 13056 (about 1-3%’
are considered mentally retarded), hut the
approaches toward teaching these gifted
children have been haphazard and
spo-758
These children are apt to get bored in
the “average” class situation. They will look
for diversion in unacceptable ways, often
inducing others to join in the fun, and their
academic performance may decline to tile
point of failure. Theme is a tendency to look
for the solution by changing to an even
slower moving class or by employing a
tutor, while overlooking the seemingly
paradox alternative of moving a poorly
per-forming child to an accelerated, more
chal-lenging class. Here the pediatrician can be
of assistance in the recognition of the
situa-tion and in the choice and timing of
ap-propriate remedial moves.
The child with behavior disturbances is
apt to continue the acquired behavior even
after a change in class situation, unless he
is given additional help at the appropriate
treatment, counseling by the school
eounse-br or social worker, and/or tutoring in a
specific subject. While some of the
counsel-ing can be done by the pediatrician, his
main function is the pivotal position he
en-joys with the child and his family, which
places him in the strategic role to
eo-ordinate the various corrective endeavors
and to prepare and motivate child and
family for the remedial procedures.
The pediatrician may not always be
pre-pared to handle such situations, either for
lack of time or lack of familiarity with
school facilities and auxiliary resources. In
this case referral to tile child psychiatrist
should be made early, after careful
prepa-ration of the family.
There are a number of educational
fac-tors which may be related to school failure,
which are primarily of a pedagogic nature,
or directly the responsibility of the school
authorities. Some of these are the teacher’s
personality and competence, frequent
teacher changes, grading systems, and the
widely discussed teaching methods in early
reading 61 While the
pedia-trician is rarely requested to intervene in
such problems, he should be sufficiently versed in them to be able to differentiate
them from other causes of school failure.
SUMMARY
Modern preventive pediatrics recognizes
that the scilool life of the child is one of the
important environmental forces affecting
his total well-being. Learning difficulties, or
any problems interfering with adequate
functioning in school, thus enter within the
province of pediatric care.
While the cause of a learning difficulty
may be purely educational, to be handled
adequately by the school authorities, the
problem is frequently more complex and
involves a variety of physical, emotional,
or social factors. The pediatrician, through
llis close acquaintance with tile child, his
family, and their environment, is in the
strategic position to seek and co-ordinate
the services needed for the correction of
these multi-faceted problems. In order to
do so he must be thoroughly acquainted
with the many factors which may interfere
with a child’s school performance so that
he can correctly evaluate the problem and
find the appropriate avenue for help in the
individual child.
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NOTE: The child is expected to be able to read each column at the end of the grade indicated. The test is
un-timed and the results can be expressed in percentages.
APPENDIX
WORD RECOGNITION TEST
. Pre-Przmer Level . Primer Level . First Grade
Second Grade Third Grade
i’irst half Second half First 1hz/f Second half
1. a 2. ball 3. blue 4. come 5. father 6. get 7. have 8. house 9. in 10. it
140
SCHOOL
FAILURE
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Acknowledgment
The authors wish to express their sincere ap-preciation to Dr. Gilbert B. Schiffman of the
Balti-more County Department of Education for his