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Ask the Adoption Medicine Expert: Academic Difficulties

“My daughter struggled in school last year. What might have caused her academic difficulties, and what can I do to help her?”by Deborah Borchers, M.D.

There are many reasons a child might struggle in school—Attention-Deficit Hyperactivity Disorder (ADHD), Sensory Processing Disorder (SPD), and learning disabilities (LD) are a few of the potential causes. Although children who were previously institutionalized may be at higher risk for learning disorders, these challenges are common to all children—as many as 20 percent of U.S. children have learning disabilities, and more than seven percent have ADHD. You’re smart to take a proactive stance, since there are many ways you can work with the school and teachers to make this year a more successful one for your daughter.

Diagnosing the problem
When a parent or teacher sees that a child is faltering, the first step is to have the pediatrician conduct a physical and neurological exam, as well as vision and hearing tests (sensory problems can trigger learning difficulties). Before the appointment, get a written report from the teacher and bring it with you. If you think your child may have ADHD, it’s helpful for the doctor if you and your child’s teacher complete the Vanderbilt Rating Scales for ADHD. (Download the screening forms at

ADHD: Although most people think that children with ADHD are in constant motion, for many (especially girls), the key indicators are an inability to maintain focus or block out distractions, and the tendency to speak or act impulsively.

Early identification of ADHD is essential. Only your child’s pediatrician can make the diagnosis, but your input, and the teacher’s, is critical. Medications are often used to correct the biological basis of this disorder, but parents and teachers can help by creating a structured environment, free of distractions, both at home and at school. To help a child meet deadlines or keep track of school materials, parents may need to teach basic organizational skills that come naturally to other kids.

SPD: Children with SPD have nervous systems that either overreact or underrespond to stimuli like sound, light, or movement. As a result, some students with SPD will thrive in a noisy classroom (and will help create that noise), while others can’t concentrate when there’s too much sound stimulation. Symptoms of SPD resemble those of ADHD, and many children are initially misdiagnosed. Other indicators of SPD may be delays in handwriting, clumsiness, and intolerance to certain room temperatures or textures of clothing.

A child should be evaluated for SPD by an occupational therapist, either at school or privately. An occupational therapist works with the child, as well as with the family and teacher, to help the child function better at home and in school.

LD: Children with learning disabilities have normal intelligence, yet they struggle academically. This can be due to difficulty processing information that they read or hear, trouble understanding mathematical concepts, or challenges with writing.

A psychologist or learning disability specialist can assess your child. After the diagnosis is made, specific teaching techniques or support services can address areas that present the greatest challenges. Most LD students can learn in the regular classroom, although some require special education or tutoring outside of school.

Lining up support
Most parents find that they achieve the most for their child when they work hand-in-hand with the teacher, both during the diagnostic process and in providing treatment. For children with mild impairments, schools may offer remedial instruction or a resource teacher. Some children qualify for programming under Section 504. Write to the “intervention team”—your child’s teacher, the principal, and the director of special education—to request an assessment of your child. The school may provide preferential seating, organization assistance, modified tests, and simplified homework assignments. If your child does not improve academically, ask for a referral for more extensive testing.

Students with significant impairments need an evaluation to qualify for an Individualized Education Program (IEP). Again, this request should be made in writing. The school’s multidisciplinary team will assess the child’s intelligence and level of schoolwork. Services under an IEP are usually more intensive, and might include special-ed teachers; teachers’ aides; and speech, occupational, and/or physical therapy. To ensure that the services your child receives continue to meet her needs, reevaluate her IEP every year.


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