Children Health And Learning
Once it was common to define a school’s mission is narrow terms focused on educational goals and methods alone. But as more and more teachers and school administrators have come to appreciate, there is an inextricable link between students’ health and their ability to leaned.
Man, Wooley, and Northrup 1998 Teachers, parents, and researchers no longer believe that a child’s success in school depends exclusively on the knowledge and academic skills that the student brings to the classroom. It is now widely recognized that learning is not an isolated process but is profoundly embedded in the complex biological, psychological. and social aspects of a child’s functioning. Students who are safe, healthy, and emotionally stable are more likely to be academically successful.
The multiple health-related domains—a student’s physical health and motor coordination, emotional well-being, ability to cooperate with other children, curiosity, and eagerness to learn—are viewed as being critically important for academic success. The acknowledgment of the role of health in learning has prompted many professional organizations to urge society to ensure that all learners receive the nutrition, health care, and general physical and emotional support they need to participate actively in and benefit from their environment—in particular, from schooling.
Despite this deep connection between health and learning, formal schooling has often been slow to engage in Mutational practices that recognize the importance of students’ health. In the nineteenth century. Elizabeth and Emily Blackwell. two of the first British-American women physicians noted that “Our school education ignores, in a thousand ways, the rules of healthy development” . In the twentieth century, educators’ gradual recognition of the role of health in learning was reinforced by the research in the natural and social sciences that confirmed the many ways in which health impacts learning. Furthermore, emerging theories of human development, as well as numerous empirical studies by psychologists, educators, and medical researchers, have pointed to the critical impact of health on learning.
The goal of this chapter is to explore the relationship between health and learning from the perspectives of theory. research. and practice and to review current and historic efforts to provide health services to school children and youth. After reviewing the current health status of our nation’s schoolchildren and youth. the chapter will briefly outline how contemporary theories of human development explain the relationship between health and learning and present some of the extensive research findings of the impact of health on learning. Finally, the chapter will review how health and other support services in schools have evolved over the last century; and offer some examples of various interventions that have been implemented in schools across the nation to promote healthy development.
Before examining more specific links between health and learning, it is important to consider the definitions of each of these domains. Health. in this context, it is understood broadly as encompassing physical vigor, mental and emotional stability, social competence, and safe and supportive environments. Thus, health, as a term, is not confined to the absence of disease; rather, it is understood more broadly as physical, mental, and social well-being. This broader understanding of the word health leads to a more comprehensive conceptualization of the link between health and learning. Learning, in the present context, is understood as the process through which children’s knowledge and understanding of various domains of experience are attained or mastered.
In other words, learning. in a general sense, refers to both the mastery of developmental tasks and the achievement of benchmarks as delineated by social norms. In educational settings. children’s learning is typically measured by academic success as indicated by grades and particularly, by performance on standardized tests. Recent education reform efforts in this country have put today’s schoolchildren and youth under increasing pressure to perform academically. The demand for skilled workers and productive citizens has contributed to the vaulting of academic achievement to the top of our nation’s political agenda.
Education is the focus of a substantial portion of the nation’s budget. However, in the face of political pressure to raise test sans, society is beginning to recognize that learning is not a simple process, but rather it is affected by a number of variables, including motivation, developmental status, and most especially by the health of the learner. In examining the critical link between health and learning we will first review the health issues confronting today’s sill, .01children, and youth.
CURRENT HEALTH STATUS OF SCHOOLCHILDREN
In recent years, the significant health needs of today’s schoolchildren and youth have become increasingly apparent to educators, health workers, and social service providers. The new morbidities—poor nutrition, unsafe sex, drug and alcohol abuse, familial and community violence, teenage pregnancy and parenting. lack of job skills, inadequate access to health care, and homelessness—are threatening the healthy development of children and youth. Children and families in the United States are facing substantial challenges to their survival and development. Census data from the last decade indicate that, in the United States, more children live in poverty than in any other industrialized country in the world.
The Annie E. Casey Foundation reports that the percentage of children and youth living in poor neighborhoods where there are large numbers of welfare recipients, unemployed individuals, and single-parent families increased from 3 percent in 1970 to 17 percent in 1990. These conditions provide a context in which growing many numbers of youth become involved in risky behavior. The 2001 Youth Behavior Survey indicated that the following percentages of 14 to 17-year-olds in the United States engaged in diverse problem behaviors:
Sexual activity: 33.4 percent had engaged in sexual intercourse during the prior three months, and 14.2 percent had had four or more sexual partners in their lifetime. Substance abuse: 29.9 percent had had five or more drinks on one or more occasions during the prior 30 days, 28.5 percent had smoked cigarettes at least once dining the prior 30 days. and 42.4 percent had smoked marijuana at least once in their lifetime. Suicide: during the prior 12 months, 8.8 percent reported attempting suicide, and 19.0 percent had seriously considered suicide. Violence: during the prior 12 months, 33.2 percent had been involved in a physical fight, and during the prior 30 days. 5.7 per-cent had carried a gun.
A leading advocate for improved youth services estimated that 25 percent of 10 to 17-year-olds engage in multiple high-risk behaviors and that another 25 percent place themselves at moderate risk by engaging in some problem behaviors. Although the remaining 50 per-cent have no or low-risk behavior involvement, they require strong and consistent support to avoid becoming involved. Flow does society make a difference in improving the health status of children and youth? Over the years, this question has been tackled by numerous professions and disciplines. At the core of this question is the notion that in order to promote positive developmental outcomes we need to understand the basic processes underlying healthy development.
In the next section. we examine what developmental psychologists believe children and youth need in order to be healthy and to succeed in school. These beliefs are embedded in theories of human development. These theories both inform and have been informed by the numerous research studies that have investigated how children develop. This discussion of theory will lay the groundwork for our subsequent discussion on effective empirical research and clinical practice.
THEORIES OF HUMAN DEVELOPMENT
Over the years, a number of theories about how children develop into adults have helped to guide the work of professionals whose role it is to promote positive and healthy outcomes for children. These develop-mental theories, while differing from one another in some ways, agree on some major fundamental principles about how human beings move from infancy through adulthood. One of the most prominent of these theories is known as “developmental-contextualism”. This theory draws on earlier theories of human development that were articulated by psychologists such as Werner (1948), Piaget, and Bronfenbrenner.
Developmental-contextual-ism proposes that development is a complex process in which the many parts of the person continuously interact with one another to produce a complex whole person. For our purposes in this book, we will discuss four of the commonly agreed-upon principles that undergird Lemer’s and other psychologists’ understanding of how humans develop. Development occurs
- In relation to the context
- At Lilo-psycho-soda!
- Across the lifespan
- In a pattern involving both risk and resilience.
It is important to note that these principles represent a change in the way psychologists have looked at development over the years. In contrast to earlier notions, development is no longer considered to be an isolated process occurring within the person, but reflects an interaction between the person and his/her environment, with each continually impacting and changing the other. Moreover, development is recognized as occurring not simply in a single domain, but simultaneously across multiple domains and levels—cognitive, emotional, biological, psychological, and social—that are continuously interacting with and changing one another. The heavy emphasis of earlier theories on the time period of childhood has evolved into a lifespan developmental perspective. Finally, in contrast to their earlier focus on developmental deficits. developmental psychologists now recognize the critical role of strengths in human development. We will review and illustrate each of these principles of development.
The first of these principles reflect our growing understanding that children’s development does not occur in a vacuum, but rather it is embedded in the various contexts in which children exist These contexts include both the immediate interpersonal or physical situation the child is in as well as the larger environment in which the child exists—that is. the particular family, school, neighborhood, culture, and society These contexts continuously affect and change the way children are developing. Safe school environments, for example, support and enhance the cognitive development of schoolchildren resulting in better learning outcomes. Furthermore, the interaction between context and development is a two-way street. Children and youth.
in turn, also shape various aspects of the diverse contexts in which they live. For example, students whose developmental progress results in academic success often contribute positively to their school environments thus leading to safer schools. The mutual impact of context and development is particularly apparent when we consider the increasing diversity of our nation’s schools. In large urban schools, for example, downs of languages may be spoken by the students’ families. It is generally agreed that immigrant children and families are profoundly impacted by their new surroundings. Although immigrant families undergo a process of acculturation. there is an increasing understanding that this is a bilateral process and that immigrant groups contribute substantial aspects of their own culture to the dominant culture. The mutual interaction of these various cultures and ethnic groups with the dominant culture reflected in the schools results in changes in school climates.
This mutual impact also requires specific interventions that are not only respectful and responsive to the diverse needs of these families. but that also promote positive racial, cultural, and ethnic identities among the students. Taking into account the multiple contexts that simultaneously impact children is a critical issue for schools, which represent one of the many institutions that have been developed by the dominant culture and organized around its value system. In summary, theories about how children develop make clear that contexts that promote children’s health and safety simultaneously pro-vide conditions that support children’s academic achievement. Conversely, contexts that impede children’s physical, emotional, and social development are likely to contribute to academic failure.
Bio Psycho Social Levels
The second principle of human development on which psychologists and others generally agree is that children’s development occurs simultaneously at many levels—biological, psychological, and social. These various levels of development are emir Ily interacting with and changing one another. We know that the biological level, for example, children’s physical-ail health, has an impact on oil their emotional and social development. A child whose health needs are chronically unmet is less likely to be successful in school or on the playground. Similarly, children whose emotional needs for love and attention are unmet are more likely to have health and learning problems.
Difficulties in any one of these areas frequently contribute to difficulties in another, sometimes resulting in so-called vicious cycles for the child. For example, poor health can lead to inconsistent school attendance, which can bring about poor school performance, which can result in negative behavior, which can contribute to negative peer interactions, which can lead to anxiety and depression, which can impact the immune system. which can result in increased illness. In a parallel fashion, success in any of these areas helps to promote success in other areas. Recognizing that malnourishment constitutes a significant barrier to learning, the Federal School Lunch Program, implemented in 1946. was developed. This principle of development helps to explain why interventions that focus on only one level of development can often be limited in their effectiveness.
For example. new methods of teaching reading will have limited success if students are malnourished and ill. Similarly, children who regularly experience family or neighborhood violence are less likely to attend classroom activities. Later in this chapter, we will describe some school-based interventions that simultaneously address multiple levels of development.
The third principle of human development involves the time period in life in which development is thought to occur. In prior decades. developmental psychologists placed a substantial emphasis on childhood. Often times, it appeared from the theory and research that development was confined to childhood and stopped at age 18. In recent years, however, it has become much more evident from the research as well as clinical practice that development continues over the course of the entire lifespan.
Adults continue to change—physically, emotionally, cognitively, and socially—for as long as they live. As a consequence, the developmental status of adults varies substantially from one adult to another. Adults, of the same age, can be at different developmental places. If they are developmentally mature, they are more likely to be positive influences on the children for whom they care. The developmental status of teachers, for example, has a significant impact on the academic achievement of children. Teachers who experience good health, positive personal and work relationships and job satisfaction are more likely to engender academic success in their students. As another example, parents who can meet children’s personal needs for safety and positive relationships are in a better position to encourage and support the academic achievement of their children.
Our understanding of development as occurring across the lifespan suggests that earlier developmental outcomes significantly impact later ones. It is now widely recognized that positive learning and social experiences in young children are more likely to contribute to their academic success as adolescents and young adults. So-called healthy starts for children—physically. emotionally, and socially—are considered crucial for later success in school. The widely acclaimed Head Start Program for preschool children was developed on the basis of this developmental principle. Head Start not only provides a positive boost to young children so that they will grow into healthy adults, but it also provides supports and training to their parents and other adults in the community.
Risk and Resilience
The final principle of human development to be presented here suggests that the direction of development can change at any point in the life of a person. Children who are developing in healthy ways can experience certain risks that might turn the course of development in a more negative direction. At the same time, children who are initially developing in negative directions can be supported to develop in more positive ways. In light of the possibility of altering the course of development, psychologists have come to recognize the critical role of strengths. The promotion of strengths can serve to buffer the effects of other negative influences on development, that is. help children to be resilient in the face of adversity. Resilience is a concept that explains how children, families, and communities are able to cope and to thrive despite environmental challenges. Resilience can be the result of individual factors such as personality or intelligence or environmental factors, such as social support or the quality of family life. Interventions that promote strengths, as well as address deficits, are more likely to lead to academic success. The impact of health on learning is mediated by interventions that incorporate strengths and diminish risks.
The key roles that risk and resilience play in development suggest that professionals working with children cannot focus on only one of these domains to the exclusion of the other. They must take both strengths and deficits into account. In the past, psychologists and other service providers have tended to adopt a more deficit-oriented approach. More recently, programs have been developed to address the promotion of strengths of children and youth. For example, the Search Institute of Minneapolis has developed a list of 40 assets that characterize children. families, and communities that can be used to support healthy development. Twenty of the assets, called external assets, focus on the positive experiences that children receive from the people and institutions in their lives.
The four categories of these assets include support, empowerment, boundaries and expectations, and constructive uses of time. In addition, there are 20 internal assets that refer to internal qualities that the community must nurture in order to promote healthy development. The four categories of internal assets include a commitment to learning, positive values, social competencies, and positive identity. In summary. these theoretical principles of human development. particularly as they are described within the perspective of “developmental-contextualism” , outline a basic explanation of how humans develop. Most critically, they help to account for the ways in which health and learning interact.
These theoretical principles of development have been supported by the large body of empirical research in child development that has occurred over the past 50 years. A significant portion of that research provides evidence of the strong relationship between health and learning. In the following section, we will review the findings of the specific studies linking health and learning.
RESEARCH LINKING HEALTH AND LEARNING
Over the past several decades there has been a substantial increase in the amount of research conducted on various aspects of child development. A large body of this research has examined factors that affect children’s learning. live types of research readily document the impact of health on learning:
- studies demonstrating that poor health leads to negative academic outcomes.
- studies demonstrating that interventions aimed at improving children’s health have a positive impact on learning. Both areas of research reinforce and illustrate the critical connection between health and learning. Let us look at each of these types of studies in turn.
Impact of Poor Health Status on Learning
Poor Physical Health and Learning Several studies have demonstrated that strong links have been found between school performance and poor physical health. Health problems identified in these studies include. but are not limited to, lead poisoning, asthma, diabetes, cancer, epilepsy, low birth weight, and other chronic illnesses. Some researchers, depending on oil their definition of chronic illness, estimate that as many as 6 to 15 percents of children and adolescents in schools are struggling with some form of chronic illness. This number can be as high as 30 percent in rural areas.
For many of these children, struggles with physical health have profound implications for academic achievement. For example. researchers have determined that children who had a low birth weight and who suffered various perinatal illnesses experience less favorable academic outcomes and more frequent school absences. In another example, several studies have shown that lead contamination—found in such various sources as house paint and yard soil—is associated with cognitive deficits and lower school achievement. Additionally, children with some types of epilepsy have difficulty succeeding academically. For example, Austin and colleagues have found that children with more severe seizures had mean scores on academic achievement tests that were below national norms.
Another critical dimension of physical health for children is the surrounding environment, particularly the school building itself. The incidence of environmentally related illnesses, such as tuberculosis, asthma, allergies. respiratory disease, depression. and violent anger is increasing and the effects of these illnesses is often overlooked in discussing factors that affect academic outcomes. One critical dimension of the physical environment for children is the school building itself. Almost one out of every two public school buildings in this nation contains an environmental hazard, such as asbestos, peeling lead-based paint, radon gas. lead-contaminated water, or biologically contaminated heating and ventilating systems. These dangerous environmental conditions have the potential to contribute to children’s and teachers’ ill-health.
Family Dysfunction and Learning
One important dimension of the well-being of children is the level of functioning of their families. Several studies have pointed to the relationship between family dysfunction and low academic achievement. Family dysfunction is often threatened children’s personal safety, which is a fundamental aspect of children’s health and well-being. One major threat to safety—child maltreatment—is becoming increasingly prevalent in children’s lives and contributes substantially to the lack of well-being and overall health of children. One-fourth of 10 to 16-year-olds report being assaulted or abused in the previous year. Both physical and sexual abuse, as well as neglect, have been implicated in a range of negative developmental and academic outcomes for school-aged children, including below aver-age intelligence quotients (IQ), learning problems, and a range of social-emotional problems—from aggression and hostility to apathy and withdrawal.
Maltreated children demonstrate less academic engagement, more social-skills deficits, and lower ego resiliency than non-maltreated children. Additionally, maltreated children mani-fest multiple forms of academic risk and show more externalizing and internalizing behavior problems conducted a study that demonstrates a significant relationship between child maltreatment and declines in a diverse set of school outcomes, including falling grades, increasing absenteeism, worsening elementary school behavior, retention in a grade, and involvement in special education programs. Academic difficulties have not only been demonstrated in children who are victims of family violence but also in children who witness family violence. Exposure to family violence has been linked with a rise in absenteeism, an increase in behavior problems, and an overall detrimental impact on the child’s school experience.
Other aspects of family dysfunction have been shown to impact learning outcomes. For example, some studies have shown that the absence of the biological father contributes to unhealthy outcomes and limited academic achievement for youth. Lykken (2001) demonstrated that boys raised in homes without the biological father are more likely to be involved in juvenile crimes. Family dysfunction can also lead to compromised living conditions for children. For example. homelessness appears to have a particularly profound influence on academic achievement. On any given night, more than 100,000 children are homeless. The disruptions caused by homelessness have been found to have a profoundly negative effect on the cognitive development and educational progress of children. Frequent moves create inconsistencies in their schooling.
In a study of homeless families in New York City, Rafferty and Rollins found that most children had transferred schools upon becoming home-less. with 33 percent having transferred between two and six times. The trouble with paperwork or other access-related issues, lack of transportation or clothing, and chronic health problems are only some of the myriad factors that cause homeless children to miss a significant amount of schooling. It has been reported that 43 percent of school-aged homeless children are not attending school at all and that 30 percent of those who are in school fall at least one grade behind their peers. Homeless children are more likely to have been retained, to be receiving special education services, and to be behind their classmates academically.
In the last decade, federal and local policies have been directed at relieving the impact of homelessness on children’s education. For example, children who move to or from a shelter can continue to be transported to and from their prior school for a specified period of time. These policies appear to be having a positive effect. For example, one recent study oral ” g the effects of homelessness on children found little or no difference between homeless children and their peers on rates of absenteeism and other school-related problems when transportation programs are used.
Community-Based Risks and Learning
Community-based risks can contribute to poor health and limited academic outcomes for children. A recent series of longitudinal studies found a direct relationship between the number of community-based risks experienced by children and the likelihood of poor academic performance. Research has also demonstrated that students are less likely to succeed when communities are economically deprived, disorganized, and lack opportunities for employment or youth involvement. These neighborhoods have effects on childhood IQ and school-leaving, even after the differences in the socioeconomic characteristics of families were taken into account. For example. the socioeconomic mix of children’s neighborhoods is related to completed years of schooling.
Research has demonstrated that youth who grow up in affluent communities or communities with a higher percentage of affluent families complete more years of school and have lower school drop-out rates than youth from similar families who grow up in poor neighborhoods or neighborhoods with fewer affluent families. Recent research has also demonstrated a link between exposure to community violence and academic functioning. Community violence generally refers to both direct victimization and witnessing potentially lethal ads of violence in a neighborhood. Although many researchers have acknowledged the negative effect of direct victimization on academic performance it is not until recently that researchers have begun to acknowledge that witnessing community violence has a negative impact on student’s learning capability as well.
For example, Overstreet and Braun found that exposure to community violence was negatively correlated with academic functioning. Additionally, in a later study, Shaver’s found that exposure to community violence significantly influenced reported behavioral pat-terns and academic performance among students.
School Time and Learning
Children’s out-of-school time has become an increasing concern in recent years. It is estimated that the parents of nearly 30 million school-age children maintain jobs outside the home, and somewhere between 7 and 15 million children return from school to an empty house on any given day (Afterschool Alliance 2000). Moreover, the National Institute on Out-of-School-Time reports that approximately 8 million children in the United States age 5 to 14 spend time without adult supervision. Cain and Hofferth report that the percentage of children who are unsupervised increases steadily with age. Unsupervised afterschool time leaves children vulnerable to a range of risk factors.
For example. these unsupervised children are more likely than their supervised peers to spend afterschool time in passive activities, averaging 23 hours of television viewing each week. Statistics indicate that risky behavior such as sexual activity, alcohol, and drug use, and juvenile crime increase significantly from 3:00 to 6:00 P.M… Further, violent juvenile crime triples and children are at a greater risk of being victims of violent crime in the afterschool hours. These risk factors contribute significantly to children’s academic difficulties.
For example, even when the family’s social class and the child’s prior adjustment are taken into account, both first and third graders who spent more time unsupervised were less socially competent and received lower academic grades in sixth grade than children who spent less time on their own. The Boston After-School Time Study found that children from low-income households displayed more behavior problems such as aggression, defiance, and hyperactivity when they were unsupervised for longer periods of time. Finally, despite the obvious need for afterschool programming, the U.S. General Accounting Office estimates that in the year 2002. the current number of out-of-school time programs for school-age children will meet as little as 25 percent of the demand in urban areas.
Negative School Climate and Learning
A negative interpersonal climate in the school also contributes to a lack of well-being in children and, ultimately, to poor school performance. School climate is broadly defined as the set of characteristics of schools and classrooms that define their interpersonal atmosphere. Schools function as organizations and have climates and cultures that can affect students in ways that go beyond their unique classroom experience. Factors that constitute a school’s climate are significant sources of variation in students’ achievement.
For example. competitive environments in middle and high schools have been associated with higher rates of delinquency, emotional distress, and diminished motivation among adolescents. When young people feel unsafe or victimized at school because of the behaviors of other students, they are more likely to suffer socially. emotionally. and academically. When schools present a negative climate and do not help students and their families to feel involved, students are less likely to succeed. School climate encompasses the personal safety of staff and students. Violence, which has become an increasing concern in our nation’s schools, poses many sorts of threats to the well-being of both students and staff. Research in this area indicates that a culture of violence has arisen in some schools, negatively affecting students, teachers, and administrators.
Students fearing violence in school may choose to cope by staying home or bringing a weapon to school. In 1995, a survey of U.S. high school students revealed that 4.5 percent of students had missed at least one day of school in the preceding month because they felt unsafe either being at school or on their way to and from school. During the same 30-day period, 1 out of 10 students and 1 out of 7 males had carried a weapon to school on one or more days. Moreover, 1 out of 12 students interviewed reported being threatened or injured with a weapon on school property, and one-third of the students had property stolen or deliberately damaged on school grounds.
One in three Latinos, one in five African Americans, and one in eight whites reported that gangs operated in their schools in 1989. Lower attendance rates and the presence of physical violence in the schools are known as contributors to poor academic outcomes. Additionally, research has demonstrated that peer groups combined with the school climate assert a powerful impact on children and adolescents in schools. One study of adolescent boys found that some schools have dominant peer groups that value academic achievement and shun violence, while other schools have dominant groups that endorse the use of violence. This research study showed that the risk of becoming involved in violence in school varied according to the peer culture in the school. despite. the adolescent% own view of violence.
Inadequate Nutrition and Learning
Inadequate nutrition has been identified in the research as an important factor in poor academic outcomes. Even moderate undernutrition or hunger can reduce children’s cognitive development and school performance. Children’s brain function, and consequently school performance, is also diminished by short-term or periodic hunger or malnutrition caused by missing or skipping meals. Several studies have indicated that omission of breakfast or consumption of an inadequate breakfast is a factor contributing to poor school performance. Cognitive defects can result from complex interactions between malnutrition and environmental insults that result from living in poverty.
Results from a recent series of surveys from nine states and the District of Columbia by the Community Childhood Hunger Identification Project provide an estimate that 4 million American children experience prolonged periodic food insufficiency and hunger each year. The same studies show that an additional 10 million children are at risk of hunger. The negative impact of inadequate nutrition on learning is an important concern for U.S. schools when one considers the extent of hunger in this country. Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction. Even children who experience food insufficiency and hunger on an intermittent basis manifest poor behavioral and academic difficulties.
Mental Health Difficulties and Learning
One of the most significant factors impacting children’s academic achievement is the status of their mental and emotional health. In the U.S. civilian population, 8.2 percent or 4.1 million children have a reported mental and/or emotional disorder (Center for Mental Health Services 2000). These youth have severe emotional or behavioral problems that significantly interfere with their daily functioning. Despite the significant percentage of children with reported emotional difficulties, these statistics are estimated to represent less than tau– the print of the true number of children under the age of 18 with serious emotional disturbance. Those children who are not reported—an estimated two-thirds of those who suffer from mental illness—often do not receive mental health services.
The Surgeon General’s 1999 report on Mental Health states that one in five children and adolescents experience the signs and symptoms of an emotional or behavioral disorder during the course of a year and that about 5 percent of all children experience extreme functional impairment as the result of a disorder. This report also estimates that 6 to 9 million children with serious emotional disturbances are not receiving the help they need—especially those children from low-income families. Mental health difficulties in children have usually manifested as either internalizing behavior or externalizing behavior. Children with internalized problems have difficulties in academic functioning. They often fail to engage in tasks that will help them to he successful.
Symptoms of depression, an internalizing disorder. are associated with lower teacher-rated grades and standardized test scores, lack of persistence in the face of academic difficulties, and a lack of classroom participation among both children and adolescents. Children with externalized distress in the form of conduct problems and/or attention problems. also evidence poor school performance. Externalizing difficulties in children are associated with poorer teacher-rated grades and standardized test scores, more time off-task in the classroom, and more behavioral problems within and outside class at school. Aggressive children are also more likely to experience social difficulties at school, such as rejection by peers and disfavor on the part of teachers.
There is strong evidence of long-term academic difficulties—such as poor achievement, poor attendance, and school dropout—among children who manifest high levels of externalized distress earlier in development. Research has also demonstrated that learning difficulties and psychosocial issues can be mutually reinforcing over time. Roeser and Eccles outline two distinct pathways explaining why academic and psychosocial difficulties co-occur in some children and why these problems exacerbate one another. In one pathway, poor school performance can lead to psychosocial difficulties.
Children who do poorly in school, and attribute the poor performance to their own personal competence. generate within themselves feelings of shame, self-doubt, low self-esteem, and alienation. These feelings often result in internalizing disorders. Similarly, children who do poorly in school, and attribute the poor performance to others, generate feelings of anger, alienation, and hostility resulting in externalizing disorders. In the second pathway, emotional distress influences cognitive processes leading to academic difficulties. Children who are struggling with anxiety or depression can experience difficulties with attention, concentration, memory. energy level, and motivation resulting in lowered academic performance.
Poverty and Learning
Chief among the conditions leading to poor health is poverty. Several studies demonstrate that poor nutrition, episodic or chronic health issues, socioemotional problems, limited physical activity, and unsafe and violence-ridden surroundings are often related to more widespread family and community poverty.