I saw a child in the OPD once, an 11-year-old kid studying in the 6th grade in an affluent school in Mumbai, the parents came complaining “our son does not get good marks in school, it’s not like he has any issues or any illness as such, I personally feel that we have spoilt him too much and he is just really lazy, all he needs is to be disciplined a little according to me, but my spouse convinced me to show you, so can you pls counsel him”. When I asked the child about why he does not study, he nonchalantly replayed “Why should I?”.
I tried explaining to him the career benefits of getting good marks vs the future consequences of being a school dropout (which I am sure his parents and a billion aunt and uncles had already done) but all he did was give me a blank stare, I am quite sure in his mind he must be thinking of when I will stop my lecture and when he can go back playing his PUBG. Should we really blame him though?
The human brain of a child in the school-going age has not yet developed enough to grasp the abstract concepts about long term benefits and harms of things (even adults don’t sometimes, just look at the people on the street during the corona lockdown). So then if the reason for which we want our children to study is difficult for them to grasp, why should they really study?
To answer this question lets first try and understand why some children do study, the answer is positive reinforcement, the famous psychologist Eric Erickson says that in the school-going age the child is most concerned with developing self-efficacy if they do a good job in the studies there are praised by their parents or teachers or colleges, their self -esteem improves, which in turn makes them study more. The exact opposite is also true if by some reason they internalize a feeling of them not being good at it, they don’t enjoy it, it makes them feel inadequate and thus they do not study.
Let us understand the process of learning and the different problems a child can face while trying to learn.
1.Unfavourable socio-cultural and environmental conditions: Children who witness domestic violence, alcoholism in parents, parental separation, child labour our more likely to not be stimulated to study. Studies have found that children from poor socio-economic status families have a higher chance of poor school performance. The noisy and violent environment at home has proven to increase the likely hood for poor school performance. A common reason in a country of many varied native languages as India is what is called as language barrier, a child who only speaks and is spoken to in his mother tongue at home might struggle to grasp a different language at school
2. Medical conditions: From something as common as worm infestations to something as rare as Thalassemia, a large number of diseases can cause a decrease in cognitive function and impair school performance. The good thing is that in some of the cases if the disease is managed then the cognitive impairment can be reversed.
Some medical factors leading to poor school performance’s
|Preterm birth and low birth weight||Leukemia and lymphoma|
|Malnutrition and nutritional deficiency’s||Sickle cell anemia|
|Asthma and allergic rhinitis||Haemophilia|
|Epilepsy||Type 1 DM|
|Cerebral palsy||Congenital hypothyroidism|
|Hearing and visual impairment||Habitual snoring|
3. Psychological and Psychiatric problems: adverse childhood experiences alone with genetic predispositions can lead to many psychiatric conditions which decrease school performance. Most common is performance anxiety where the child freezes in the exam with the fear of failure, a child can have depression where he feels hopeless, helpless and worthless in life and does not feel like doing anything leave aside studying. Some children have what is personality traits of being vengeful, destructive, argumentative, defiance, they oppose authority for the sake of opposing authority, the technical term for this is called opposition defiant disorder. Others suffer from what is called as conduct disorder where a child compulsively lies, steal’s, sets property on fire, bullies, is destructive.
4.Visual/Hearing impairment: A child might see a blur instead of alphabets on the blackboard, the voice of the teacher might be less audible to him from the backbenches, if the impairment is not too severe, he does not even realize that there is a problem, he thinks everyone can see and hear the same way he does. A child with moderate to mild hearing and/or visual impairment decreasing school performance goes unnoticed more commonly then u think.
5. Attention-deficit / hyperactivity disorder (ADHD)
ADHD is a common cause of poor school performance and always should be investigated, as it is subject to specific treatment with a good outcome. The common complaint from the parents and the child is that he forgets what he has studied. The problem is that he has not been able to pay enough attention in the first place so the study material has not registered. It’s like we are blaming the CPU performance when the problem lies in the keyboard.
6. Below average intelligence
The general intelligence is an important prognostic variable in the academic outcome, children with borderline intelligence (IQ 71 to 84) or Intellectual Disable children (IQ<70) present with poor school performance or school failure. These children more often than not have a history of delayed milestones.
7. Learning disabilities
LD is related to problems of acquisition and development of brain functions involved in learning and learning only, it has nothing to do with the general IQ of the individual. The child can have a superior IQ but still have a learning disability. They include Dyslexia, dyscalculia, and Dysgraphia.
|Type of learning disability||Characteristics|
|Difficulty in identifying the letters. Confusion in letters having opposed orientations
or small writing differences (p/1 – b/d – c/e – u/v – i/j – n/u) or similar sounds (b/p –d/t)
|Difficulty in learning letter-sound. This leads to a syllable or word inversion (sun/snu), substitutions in similar structure words; letter or syllable suppression or addition (marine/mariner); syllable or word repetition.|
|Confusion in time-space relationships, body scheme, and laterality|
|Letter mixture (capital/lower case, print/cursive)|
|Letter tracing incompleteness|
|Visuomotor (copying) and visuospatial difficulty|
|Number writing error (mirror writing)|
|Difficulty in signs of mathematical operations|
|Difficulty in setting a mathematical operation up and in ordering and dividing the
numbers into spaces
|Difficulty in reading multi-digit numbers.|
When assessing kids with poor school performance we check for the factors mentioned above in the sequence I have written them in. If a child has difficulty in any step, that step is managed first and only then the subsequent steps are assessed. For example, if a child has performance anxiety, we treat it first before performing the IQ. If the child has ADHD then we manage it first and only then look for learning disability.
To summarize, not feeling like studying is not the problem but the symptom of the problem. Just like if we find our job difficult to do and if we are constantly criticized for it, we would not feel like going to work, children who have some difficulty don’t feel like studying. Rather then blaming the child it is better if we solve the problem and help him.