School Functioning Issues in Children with Chronic Health Conditions

Some school problems for children with chronic health conditions are due to the requirements of the treatment and the effects of the condition.

• Children may need to miss school for scheduled treatment or medical procedures, or they may be required to remain at home to reduce the risk of sickness.
• A chronic health condition and its treatment can sap children’s energy at times, making it difficult for them to give their full attention in class and complete assignments.
• Pain and discomfort can make it hard for a child to endure a long day at school and complete homework in the evening.

Emotional and social issues can get in the way of school achievement.

• Feelings of sadness and worry can diminish the optimism and drive needed to do well in school. Children with chronic health conditions may worry about their health prospects, fear an upcoming treatment, or feel grief over the loss of physical abilities.
• If a child does not have a supportive group of friends and teachers at school, who are aware of the illness and accept the child for who he or she is, feelings of being “different” can lead to problems with self-esteem and self-image. These negative feelings can hurt school performance.
• Chronic health conditions can also be associated with depression and with pediatric traumatic stress, either of which can interfere with motivation, concentration and healthy sleep habits.

Some conditions can also lead to cognitive impairments — problems with brain functioning — that can impact school performance. This can occur, for example, with brain tumor, stroke, seizure disorder or sickle-cell disease. Chemotherapy and cranial radiation therapy can also have an effect on brain function (known as neurocognitive late effect).

School functioning issues are cognitive, behavioral or emotional side effects that can sometimes accompany a chronic condition or its treatment. Signs of school functioning issues are usually easy to spot, but families and teachers may just view these changes as temporary. Signs include a decrease in energy or motivation with homework, an inability to complete assignments, and a drop in grades.

Parents of children with chronic health conditions should work closely with their child’s school so that teachers are aware of any special requirements the child needs. Arrangements should be made to help keep up with schoolwork when a child can’t be at school. If parents and teachers are communicating and working together, school problems should be noticed quickly.

If the school problems are tied to depression, medical traumatic stress or other emotional problems, those conditions have their own signs and symptoms, and can be treated.

If your child is suffering from school functioning issues, talk with your child’s doctor. The medical team working with you and your child can develop a plan to address his or her specific issues. A neuropsychological assessment is a possible first step with recommendations for the patient, family and school.

The steps needed to address school performance problems will depend on the age of the child and the nature and cause of the problem.

• If the condition or its treatment is leaving a child too tired or uncomfortable to pay close attention in class or keep up with school work, the child’s doctor may be able to suggest changes that could give the child more energy or reduce discomfort.
• If absences are required for treatment or recuperation, or to avoid contagious illness, a parent can work with the school to continue instruction online or to get assignments the child can do outside of school to keep up with the class.
• If emotional issues, such as worry, sadness or low self-image are interfering with school performance, a child or adolescent psychologist can work with the child and the family. Cognitive behavior therapy or psychotherapy can be used to change negative thought patterns and build confidence and optimism. A psychologist can also help the child address problems with any social issues, such as fear of standing out from peers and ways to respond to insensitive comments from other children.
• If the condition or its treatment has had a neurological effect, a doctor can explain how this may be affecting the child’s learning. All children learn in different ways, and children with neurological changes may need to adopt different approaches to learning. The Executive Function Consultation, Education and Skills (EXCEL) Clinic at CHOP provides services and information for families of young cancer patients whose condition or treatment may put them at risk for executive functioning weakness.
• In some cases, medication may be prescribed to the patient to address emotional problems.
• Parents should collaborate and communicate regularly with the child’s teachers to address school performance problems, and work with school administrators on any needed accommodations. It’s important that parents and teachers share information on the steps being taken at school and at home to address the problems and track progress.

With attention, collaboration between parents and teachers, and a multidisciplinary approach incorporating medical and behavioral support, school functioning issues can usually be corrected. When emotional issues are the cause, expert guidance and counseling is generally successful in helping children learn healthy ways to cope.

If long-term treatment is needed for the chronic condition, parents should continue to pay attention to school issues. Behavior may change in adolescence, so a child who is able to navigate school and medical care in the early school-age years may begin to have problems in the teenage years. The demands of school also naturally increase during this time in an adolescent’s life. Some of this is additionally a normal part of growing up, as teenagers begin to exert their independence and push back against the demands of others.

Even children without chronic illness can experience ups and downs in their success at school, so parents should be careful not to attribute all school problems to issues related to the medical condition.

Children’s Hospital of Philadelphia (CHOP) has a skilled team of child and adolescent psychiatrists, psychologists, neuropsychologists, nurse practitioners, social workers and more, who work in collaboration to support children with chronic illnesses and their families. School performance is an important part of all of our patients’ lives, and we have worked with hundreds of young patients as they navigate the treatment for their illnesses while staying successfully engaged at school.