Assessment of an Itinerant Medical Evaluation Program for School Dysfunction
Sandler, Adrian D., Journal of School Health
Despite efforts by public schools to identify and assist children with learning disabilities, enormous numbers of children continue to struggle in school. One of the most important reasons is unrecognized comorbidity, including attention disorders, emotional problems, neurologic disorders, sensory impairments, and information processing dysfunctions. For example, in one recent study of 116 children with continued school dysfunction, 45% of those enrolled in special education had previously undiagnosed ADHD. Other psychiatric comorbidity was present in 23% of the sample. Clearly, children who straggle in school are a heterogenous population requiting multidisciplinary evaluation and careful, well-planned interventions.[2,3] Some authors, including psychologists and educators, have emphasized the need for thorough medical evaluation in some children and adolescents with school dysfunction.[1,2,4]
Research programs in the past 10 years have identified the major cognitive mechanisms underlying dyslexia and other learning disabilities? Much has been learned about how the assessment of these mechanisms can help predict the course and outcome of learning disabilities. Moreover, this research has guided the development of specific educational and psychological interventions that have the potential to ameliorate the devastating effects of learning disabilities. Unfortunately, wide gaps exist between learning disabilities research and classroom practice[6,7] A need exists in regular education settings for individualized educational strategies. To accomplish this requires considerable investment of resources as well as extensive support for teachers. Consultative evaluation and technical assistance from specialists familiar with learning disabilities research can be helpful in closing the gap between research and classroom practice, potentially improving outcomes for students who continue to struggle.
The role that medical consultation can play in closing the gap between educational research and classroom practice for children with learning disabilities is worthy of study. There are many conceivable models of pediatric involvement in the assessment and management of children with school problems. Pediatricians around the country are engaged in traditional screening for associated health problems, prescribing medications for attentional problems, or fulfilling a more extensive role as diagnosticians and longterm care coordinators. The American Academy of Pediatrics has published policy statements regarding the role of pediatricians in the development and implementation of educational plans and provision of related services in schools.[9,10] Despite this, there continues to be some controversy regarding the pediatrician's role. Most agree that pediatricians should be a resource to the schools, and that such work can help children with disabilities to reach their potential.
Unfortunately, very little empiric data exists about the effectiveness of itinerant or school-based medical evaluation or intervention programs for children with school problems. A literature search located only one such publication in the past five years. In that study, the San Diego School District instituted the Project for Attention-Related Disorders (PARD), an approach to identification, referral, and management of children with ADHD which coordinated medical, psychosocial, behavioral, and educational interventions, and provided resources to teachers. Outcomes were evaluated three years after starting PARD, and the authors reported that about two-thirds of the children showed improvement.
In 1995, the Department of Health, Environment and Natural Resources of the State of North Carolina, recognizing that many children with school problems lacked access to appropriate medical evaluations, funded four pilot projects in the state. The purpose of the projects was to draw upon local resources to develop models of providing consultative evaluations to schools. …