Common Problems at School Age

Attention Deficit and Hyperactivity Disorder

Hyperactivity is characterised by overactivity, difficulty keeping still and restlessness. It can be so extreme as to impair learning and disrupt classes. These children can be impulsive and excitable. Children with attention deficit disorder have difficulty concentrating on a task. It may or may not occur with hyperactivity (when it is known as ADHD) and is more common in boys.

Diagnosis of ADHD requires independent reporting by family and school as well as direct observation of the child. The problems need to be pervasive (present in different settings). Management includes strategies to reduce distraction, focus on task, build concentration, and provision of a calm regular daily routine with consistent boundaries. Support with teaching assistance may be helpful to help the child focus on tasks. Central nervous system (CNS) stimulant drugs such as methylphenidate can help improve concentration but behavioural strategies are preferable.

Aggressive Behaviour

Temper tantrums with shouting and physical outbursts are normal in the toddler years but should settle as children learn to control their anger and frustration through consistent parenting. Aggressive behaviour in children is very rarely caused by medical illness (e.g. precocious puberty, frontal lobe problems). It is most often behaviour that the child has learned from their home environment by adults showing verbal or physical aggression, for example if the child witnesses domestic violence. Aggressive children may be involved in bullying in school and further social problems beyond. If persistent then the description ‘conduct disorder’ is some­times applied. Maintaining a calm environment with emotional warmth and clear boundaries at home is necessary. School staff should be involved along with parents in order to address peer problems, academic or social problems and to institute behaviour modification.

Teasing and Bullying

Bullying is when a child deliberately behaves in a way that upsets or frightens another child. This can be a single episode or repeated over long periods of time and can lead to significant distress. The bullied child may react by becoming withdrawn or aggressive, or may develop illness symptoms. In schools where bullying is a problem, a whole-school approach where both the victims and the bullies are helped is most effective. The bullied child needs to feel safe and supported if they disclose. They need help in handling the situation and to increase social confidence.

Non-Attendance at School

Most absences from school occur as a result of acute illness, which is usually minor, but may be prolonged through parental anxiety. School refusal may be due to separation anxiety (common on first starting school) or school phobia (usually triggered by distressing events, such as problems with peers). There may be abnormal attachment affecting the parent–child relationship. The child may have non-specific illness symptoms and social withdrawal.

Truancy is most common at secondary school age. Persistent truancy is associated with antisocial behaviour, poor academic achievement and family relationship problems.

Management of both must involve close collaboration between the parents and teachers. The child should be supported in a gradual return to full school attendance through a combined approach between parents, school, child health and child psy­chology. Truancy is managed with school or education welfare staff.

Severe Educational Difficulties

Reasons for severe educational difficulties include the following.

Developmental Problems

• Learning difficulties
  
• ADHD
  
• Hearing or visual deficit
  
• Dyslexia
  
• Dyspraxia
  
• Autistic spectrum disorder

Social Problems

• Family problems at home
  
• Emotional, physical, sexual abuse or neglect
  
• Peer problems
  
• Absence from school

School failure is associated with low self-esteem, behavioural difficulties, psychosomatic disorders and has profound effects on adult life. It is important to resolve the problems as early as possible.

Dyslexia

Dyslexia is the most common type of specific learning difficulty. The dyslexic child is unable to process effectively the information required in order to read. The result is a reading ability below that expected for the child’s level of intelligence. Children may struggle with spelling and handwriting.

There may be a history of early language delay. If this is unrecognized the child is likely to fail at school, and may respond by withdrawing or disruptive behaviour. The diagnosis should be confirmed by an educational psychologist, and individual help is required to overcome the difficulties. Strategies to help children with dyslexia include allowing extra time to complete written tasks, use of computers as writing aids and adapting the presentation of information to suit their learning style.

Dyspraxia

Motor incoordination leads to significant problems with handwriting, and difficulty with sports and with practical tasks such as dressing and eating with cutlery. If it is disproportionate to their general developmental ability the term ‘dyspraxia’ or ‘developmental coordination disorder’ may be applied. The academic and social difficulties that ensue can cause unhappiness and behaviour problems. Occupational therapists have experience in assessing the level of difficulties and can assist in devising therapy programmes, sometimes using equipment to reduce the functional difficulties.