1. Learning disabilities. As defined by federal legislation: Specific learning disability means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations.

The term includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include children who have problems that are primarily the result of visual, hearing, or motor disabilities; intellectual disability; emotional disturbance; or environmental, cultural, or economic disadvantage. Family, genetic, cognitive, and neuroanatomical factors are all implicated as etiologies for LDs.

LDs are traditionally characterized by a discrepancy between ability (as measured by intelligence tests) and actual academic achievement. Federal guidelines also ask whether a child could achieve at a level commensurate with age and ability if provided with appropriate learning experiences. Their prevalence is estimated at 3%-5% of schoolchildren. Although most children with LDs have underlying weaknesses in language function, weaknesses in other higher-order cognitive functions (so-called metacognitive skills) have been increasingly recognized among children with nonverbal LDs. Such children may have difficulties with reasoning, memory, or focusing their attention and have been described as “passive learners” because of their difficulties with selecting strategies for problem solving.

2. Attention deficits (see Chapter 25). There exists significant overlap between children with LD and attention-deficit/hyperactivity disorder (ADHD). From a clinical standpoint, distinguishing between children with an intrinsic deficit of attention and those with attention deficits secondary to other developmental and behavioral dysfunctions (e.g., language impairment, depression) is often difficult.

3. Intellectual disability (see Chapters 51 and 52). Mild disability (i.e., IQ in the 50-70 range) is often not identified until children are confronted with the cognitive demands of school. At that time, a slow learning rate and ultimate acquisition of academic skills up to the fifth- or sixth-grade level is typically seen.

4. Sensory impairment. Hearing loss results in a significant educational handicap because language acquisition and communication skills are impaired. Such students typically experience difficulties in reading, arithmetic reasoning, and problem solving. They may exhibit classroom maladjustment, behavioral problems, and social immaturity. The prognosis directly relates to the age at which identification occurs. In comparison, blind children usually fare better within the classroom. Visually impaired children who experience school failure tend to have additional handicaps.

5. Emotional illness. From 30%-80% of emotionally disturbed students have problems with academic achievement and classroom behavior. Emotional problems such as low self-esteem and poor self-image often exacerbate school failure brought on by other causes, such as LD or ADHD.

6. Chronic illness. From 25%-33% of chronically ill students have problems with academic achievement (see Chapter 36). Possible adverse influences on school performance include limited alertness or stamina, chronic pain, medication side effects, absenteeism, emotional maladjustment, low intelligence (primarily children with certain neurologic disorders), the inferior quality of alternative classroom placement, and inappropriate or unrealistic expectations by teachers and parents. In addition, certain chronic diseases (e.g., epilepsy, cerebral palsy, myelomeningocele) are associated with an increased incidence of LD.

7. Temperamental dysfunction (see Chapter 81). The temperamentally “difficult” student may become easily frustrated and angry when confronted with material not easily mastered. The initial reluctance to participate and tendency to withdraw of the “slow-to-warm-up” child may be misinterpreted as anxiety or as a limited capacity for learning. Although the temperamentally “easy” student usually fares well, problems may arise when expectations for behavior markedly differ between home and school. For example, a student’s mild intensity of reaction to situations or stimuli may be misinterpreted within the classroom as a lack of interest or motivation.

8. Family dysfunction and social problems. Family issues that contribute to school failure include parental separation and divorce, child abuse and neglect, the illness or death of an immediate family member, parental psychopathology, early parenthood, substance abuse, and poverty.

9. Ineffective schooling. School processes are more important determinants of students’ performance than such features as whether schools are public or private, class size, the age and spaciousness of school buildings, and student teacher ratio. Rather, the school’s academic emphasis, expectations for attainment, amount of homework, teachers’ actions during lessons, use of group instruction, and the use of rewards and praise have major influences on students’ performance. Aspects of the school’s social environment (such as the amount of praise offered to children) may be particularly important for children from disadvantaged homes in which less emphasis is placed on academic attainment and standards for classroom behavior. Knowledge of the relationships between school effectiveness and school achievement has important implications for assessing and promoting both individual student performance and public policy.