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Indian Pediatr 2013;50:
655-658 |
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Risk Factors for Scholastic Backwardness in
Children
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K Haneesh, *P Krishnakumar,
#Sowmya K Sukumaran and A
Riyaz
From the Department of Pediatrics, Institute of Maternal and Child
Health, Medical College, Calicut; and *Institute of Mental Health and
Neurosciences (IMHANS) Medical College, Kozhikode; Kerala, India.
Correspondence to: Dr P Krishnakumar, Aswathy; Vishnunagar,
Thondayad, Post Chevarambalam,
Calicut, Kerala 673 017, India. Email:
[email protected]
Received: August 09, 2012;
Initial review: August 14, 2012;
Accepted: November 12, 2012.
PII:
S097475591200727
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Aim: To identify the risk factors for scholastic backwardness in
children.
Participants: Children in the 6-12 year age group
attending regular schools and referred to the child guidance clinic for
scholastic backwardness.
Setting: Tertiary care hospital in South India.
Methods: Participants were compared with an
age-and sex- matched group of children with good academic performance,
to ascertain risk factors for scholastic backwardness.
Results: There were 75 boys and 35 girls in the
study group. Among them 30 (27%) children had mental retardation, 39
(36%) had borderline intelligence and 12 (11%) had microcephaly.
Undernutrition was noted in 36 (33%) children and 31 (28%) had stunted
growth. 28 (26%) children had a history of chronic medical problems like
epilepsy, bronchial asthma and congenital heart diseases. Visual,
hearing and speech defects were present in 6 (6%), 5 (5%) and 12 (11%)
children, respectively. Statistically significant differences were noted
in the educational level and employment status of parents of children
with scholastic backwardness and those with good academic performance.
Conclusion: Social and family factors have a
significant influence on the academic functioning of children.
Key words: Children, Risk factors, Scholastic backwardness.
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Academic underachievement of children is a big
concern among parents and teachers in present day competitive society.
It is reported that around 20% of school children have scholastic
backwardness [1]. Factors associated with scholastic backwardness
include physical illnesses, below average intelligence, learning
disorders, attention deficit hyperactivity disorder, psychiatric
disorders, family and school factors [1,2]. Scholastic backwardness
contributes to school dropout, especially after the primary school years
[3] and should be recognized and remedial measures initiated, in the
primary classes itself for best results. At present, children are
identified much later and as a result, optimum benefit of remedial
education is not obtained. It is important to identify the risk factors
for scholastic backwardness so that these children can be identified
early and corrective measures initiated. The aim of the present study
was to identify the risk factors for scholastic backwardness in
children.
Methods
The study was conducted at the Child Development
Services of the Institute of Mental Health and Neurosciences (IMHANS)
and the Child Guidance Clinic (CGC) at the Department of Paediatrics,
Medical College, Calicut during the period of one year from November
2008 to October 2009.
Children in the 6-12 year age group who were referred
to the CGC during the study period for scholastic backwardness and who
satisfied the inclusion criteria were taken up for the study. Regular
school-going children whose parents gave consent were included. Children
diagnosed to have progressive neurological disorders were not included.
Children with hemophilia, hemolytic anemia, leukemia and HIV infection
and those with physical illnesses that could interfere with assessment
were also not included.
A child was considered to have scholastic
backwardness if he or she failed regularly in all subjects or had class
failure (detention) in the previous year. Diagnosis of scholastic
backwardness was made based on information provided by parents, teacher
reports and individual evaluation. Each child and his/her parent were
interviewed together and separately. Detailed clinical examination and
relevant investigations were done. A report from the class teacher
regarding the functioning of the child in the school including general
activity in the class, relationship with students and teachers, academic
functioning, play and extracurricular activities was obtained. Children
were evaluated using a semi-structured proforma to elicit
socio-demographic data and clinical history data. Binet- Kamath test was
used for IQ assessment [4] and the psychiatric diagnoses were made based
on DSMIV diagnostic criteria [5].
Children in the study group were compared with an
age-and sex-matched group of children with good academic performance to
ascertain risk factors for scholastic backwardness. Only those children
who regularly got A grade or B grade in all subjects were considered to
have good academic performance. The children with good academic
achievement were selected from four schools in rural areas which
included two aided and two government schools. The study was approved by
the Institutional ethics committee of Governmental Medical College,
Calicut.
The data were analyzed using the software SPSS for
Windows (version 10.0). Chi square test and student’s ‘t’ test
were used for comparison.
Results
The study group consisted of 110 children with
scholastic backwardness. There were 75 boys and 35 girls in the 7 to 12
year age group studying in classes from 1st standard to 7 th
standard, with a mean age of 9.6 years. 30 (27%) children had mental
retardation. Among them 25 (23%) had mild mental retardation and 5 (5%)
had moderate to severe mental retardation. 41(37%) had normal
intelligence and 39 (36%) had borderline intelligence. Head
circumference was normal in 84 (76%) children while 12 (11%) had
microcephaly. 36 (33%) children had under-nutrition and 31 (28%) had
stunted growth. 28 (26%) children had a history of chronic medical
problems which included epilepsy, bronchial asthma and congenital heart
disease. One child had congenital hypothyroidism. Visual, hearing and
speech impairment was present in 6 (6%), 5 (5%) and 12 (11%) children,
respectively.
The common psychiatric disorders noted were Attention
deficit hyperactivity disorder (22;20%) and Oppositional defiant
disorder in (11;10%). Non-specific behavior problems were present in
21(19%) children. 5% had motor tics and an equal number of children had
stereotypic movements.
34 (31%) children were born as low birth weight
babies. Antenatal, natal or post natal complications like maternal PIH,
maternal gestational diabetes mellitus, birth asphyxia, neonatal
seizures, jaundice or respiratory distress were present in 29 (26%)
children. Developmental milestones were delayed in 48 (44%) children.
Among them 20 (18 %) had global developmental delay. Isolated motor
developmental delay was noted in 5 (5%) children and isolated language
delay was present in 23 (21%) children.
The group of children with good academic performance
included 110 children. Statistically significant differences were noted
between the educational status and employment level of parents of
children with scholastic backwardness and those with good academic
performance. Fathers of the majority of children with scholastic
backwardness were unskilled workers. Majority of the mothers were
unemployed or unskilled workers (Table I). Fathers of
majority of children had studied up to primary or high school level.
Among the mothers of children with scholastic backwardness, majority had
high school education while only 10(9%) were graduates (Table
I).
TABLE I Employment and Education Status of Parents
Employment status |
Father |
Mother |
|
Case
|
Control |
Case |
Control
|
|
No. (%) |
No. (%)
|
No. (%) |
No. (%)
|
Employment status |
Un-employed |
6 (5) |
3 (3) |
95 (86) |
90 (82) |
Unskilled worker |
60 (55) |
16 (17) |
13 (12) |
2 (2) |
Skilled worker |
19 (17) |
11 (10) |
1 (1) |
1 (1) |
Self employed |
7 (6) |
38 (35) |
1 (1) |
2 (2) |
Govt. / public sector |
7 (6) |
23 (21) |
0 |
13 (12) |
NRI* |
11 (10) |
17 (16) |
- |
- |
Professional |
0 |
2 (2) |
0 |
2 (2) |
Educational status |
Primary |
34 (31) |
12 (11) |
21 (19) |
6 (6) |
High school
|
67 (61) |
60 (55) |
59 (53) |
44 (40) |
Pre-degree
|
5 (5) |
18 (16) |
20 (18) |
33 (30) |
Graduate & above |
4 (4) |
20 (18) |
10 (9) |
27 (24) |
*NRI: Non-resident Indian. |
Chronic medical illnesses, perinatal problems, low
birth weight, developmental delay, family history of mental illness or
mental retardation and parental alcoholism were significantly more in
children with scholastic backwardness (Table II).
TABLE II Risk Factors for Scholastic Backwardness
Risk factor |
Cases (%) |
Controls(%) |
Low birth weight |
34 (31) |
10 (9) |
Perinatal insult |
29 (26) |
3 (3) |
Delayed Development |
48 (44) |
6 (5) |
Chronic medical illness |
28 (26) |
1 (1) |
Family history of mental illness |
36 (33) |
2 (2) |
Family history of mental retardation |
16 (15) |
2 (2) |
Family history of epilepsy
|
20 (18) |
3 (3) |
Parental alcoholism |
24 (22) |
3 (3) |
P< 0.001 for all factors. |
When children with normal intelligence and scholastic
backwardness were analyzed separately it was found that family history
of mental illness (15; 37%), family history of mental retardation (11;
27%), family history of epilepsy 7 (17%), parental alcoholism 11; 27%),
perinatal brain insult (8; 20%) and chronic medical problems (7; 17%)
were significantly more in children with scholastic backwardness
compared to children with good academic performance.
Discussion
In the present study, significant differences were
noted in the educational status and employment level of parents of
children with scholastic backwardness and those without scholastic
backwardness. Previous studies have found that academic achievement is
significantly influenced by the socioeconomic and cultural milieu of the
family and parental involvement in school activities [6-8]. Lower
education status of the father and unhappy family were found to predict
poor scholastic performance in adolescents in a study from Kerala [9].
School absenteeism was reported to be greater in students whose fathers
were laborers or self-employed and whose mothers had lower educational
levels [10]. This may contribute to lower academic performance in
children. Apart from socioeconomic factors and parental education, other
factors in the family environment also influence academic functioning of
children. It was reported that disturbing factors at home including
quarrels between parents and siblings, broken homes, substance abuse in
parents and being burdened by domestic responsibilities were more in low
achievers compared to high achievers [11]. A healthy family environment
fosters academic achievement.
Studies have shown that quality of the diet and when
meals are eaten also influences academic functioning [12-14]. In our
study, chronic medical illnesses were found to be significantly more in
children with scholastic backwardness. It is well established that
children with chronic illnesses have poor academic functioning compared
to healthy children [15-19]. The low achievement is not simply a result
of school absenteeism due to the illness, but due to the inherent
aspects of the illness [17, 18]. Children with chronic illnesses and the
added disadvantage of low socioeconomic status, are at particular risk
for poor school achievement [16]. This emphasizes the importance of
providing educational support to children with chronic illnesses.
The Pune low birth weight study found that LBW babies
on follow up at the age of 6 years and 12 years have significantly lower
IQ scores and poor visuo-motor perception and poor academic achievement
compared to controls [20, 21]. Other studies have also reported that
perinatal brain insults and low birth weight are risk factors for
scholastic backwardness [22-24]. Our findings are consistent with these
observations.
Learning disorder (LD) is an important cause of
scholastic backwardness in children with normal intelligence [1, 2]. In
the present sample, among children with normal intelligence, there were
several children with features of LD. Due to the difficulty in getting a
standardized tool we could not evaluate the exact percentage of children
with LD in the sample. This is a limitation of the study. Another
limitation is that children with scholastic backwardness were selected
from children referred to the CGC for evaluation whereas children with
good academic performance were selected from schools. Ideally both
groups should have been hospital-based samples, but due to practical
difficulties we could not get a hospital-based sample of children with
good academic performance for comparison. This fact should be considered
while interpreting the results.
Acknowledgments: Dr Biju George, Associate
Professor, Department of Community Medicine, Medical College, Kozhikode
for helping with statistical analysis; Dr Geeta M Govindaraj, Additional
Professor of Pediatrics, Medical College, Kozhikode for help in
preparation of the manuscript.
Contributors: KH: Collected and analyzed
the data; PK: Designed the study, helped in literature review and data
collection and wrote the paper. He will act as the guarantor for the
paper; SKS: did the psychological assessment including IQ assessment and
AR: Helped in study design and data collection and writing the paper.
Funding: None; Competing interests: None
stated.
What is Already Known?
• Scholastic backwardness is a common problem
among school going children.
What This Study Adds?
• Chronic medical illnesses, perinatal
insult, low birth weight and delayed development are risk
factors for scholastic backwardness. Family history of mental
illness or mental retardation, parental alcoholism and low
educational and employment status of parents are associated with
scholastic backwardness in children.
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