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* This is the Professional Version. *

School Problems in Adolescents

By Sharon Levy, MD, MPH

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School constitutes a large part of an adolescent’s existence. Difficulties in almost any area of life often manifest as school problems.

Learning disorders (see Overview of Learning Disorders) may manifest for the first time as school becomes more demanding, particularly among bright children who previously had been able to accommodate for their areas of weakness.

Sometimes, mild intellectual disability (see Intellectual Disability) that was not recognized earlier in life causes school problems. Behavior problems that developed earlier in childhood, such as attention-deficit/hyperactivity disorder (ADHD—see Attention-Deficit/Hyperactivity Disorder (ADD, ADHD)), may continue to cause school problems for adolescents.

Particular school problems include

  • Fear of going to school

  • Absenteeism without permission (truancy)

  • Dropping out

  • Academic underachievement

Between 1% and 5% of adolescents develop fear of going to school. This fear may be generalized or related to a particular person (a teacher or another student—see also School Avoidance) or event at school (such as physical education class). The adolescent may develop physical symptoms, such as abdominal pain, or may simply refuse to go to school. School personnel and family members should identify the reason, if any, for the fear and encourage the adolescent to attend school.

Adolescents who are repeatedly truant or drop out of school have made a conscious decision to miss school. These adolescents generally have poor academic achievement and have had little success with or felt little satisfaction resulting from participation in school-related activities. They often have engaged in high-risk behaviors, such as having unprotected sex, taking drugs, and engaging in violence. Adolescents at risk of dropping out should be made aware of other educational options, such as vocational training and alternative programs.

School problems during the adolescent years may be the result of

  • Rebellion and a need for independence (most common)

  • Mental health disorders, such as anxiety or depression

  • Substance use

  • Family conflict

  • Learning disorders

  • Behavior disorders

As adolescents begin to seek more freedom, their desire to do so may clash with their parents' desire to keep them safe. Adolescents rebel in various ways, such as refusing to attend school or drinking alcohol. Adolescents who are anxious or depressed may refuse therapy or stop taking their prescribed drugs. All of these challenging behaviors can cause problems within the family and at school.

Diagnosis

  • Learning and mental health evaluations

In general, adolescents with significant school problems should undergo complete learning and mental health evaluations.

Treatment

  • Treatment of cause

School problems, especially when related to learning or attention difficulties, should be addressed by clinicians, working together with school personnel and parents. If a learning disorder or intellectual disability is present, appropriate services should be provided through an individualized educational plan (IEP). Environmental changes and sometimes drug therapy can be of great help to struggling students.

* This is the Professional Version. *