Resources

Understanding Your Child's Learning

Evidence-based information for parents and educators. Each section below provides clinical context, research-backed strategies, and practical recommendations to help children thrive at school and at home.

Key Facts

Specific Learning Disabilities (SLD) affect an estimated 5–15% of school-age children across all cultures and languages, according to the DSM-5-TR. Under the Individuals with Disabilities Education Act (IDEA), SLD is the most common category of special education eligibility, accounting for approximately 33% of all students who receive special education services.

Children with SLD have average to above-average intelligence. The core issue is a neurodevelopmental difference in how the brain processes specific types of information — not a lack of effort, motivation, or ability.

A Specific Learning Disability is a disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, that may manifest in the imperfect ability to listen, think, speak, read, write, spell, or perform mathematical calculations. Federal law (IDEA, 2004) requires that learning disabilities not be primarily the result of visual, hearing, or motor disabilities; intellectual disability; emotional disturbance; or environmental, cultural, or economic disadvantage.

Clinical Definition

A Specific Learning Disability in Reading is characterized by persistent difficulties with accurate and/or fluent word recognition, poor decoding ability, and difficulties with reading comprehension. These difficulties are unexpected relative to the child's age, cognitive ability, and exposure to effective instruction. Research conducted by the National Institute of Child Health and Human Development (NICHD) has demonstrated that reading disabilities are neurobiological in origin, involving differences in brain regions associated with phonological processing — particularly the left temporoparietal and occipitotemporal areas.

How It Appears at School

Early Elementary (K–2): Difficulty learning letter-sound correspondences, slow to decode simple words, trouble rhyming or segmenting sounds in words, limited sight word recognition, and frustration during reading activities. The child may avoid reading aloud or guess at words based on pictures or first letters.

Upper Elementary (3–5): Slow, labored reading that significantly lags behind peers, difficulty with multisyllabic words, limited reading comprehension despite strong oral language, avoiding reading-heavy assignments, and difficulty spelling even common words. Written output may be significantly below the child's verbal ability.

Middle and High School: Continued slow reading rate that affects performance across all content areas, difficulty with textbook reading, avoidance of reading for pleasure, struggles with vocabulary development that depends on reading exposure, and reliance on audiobooks or peer notes to access content.

How It Appears at Home

  • Avoids reading independently; may resist bedtime reading or homework involving reading
  • Guesses at words or skips words when reading aloud
  • Has difficulty sounding out unfamiliar words
  • May have strong verbal abilities but struggles significantly with anything in print
  • Shows frustration, anxiety, or low self-esteem related to reading tasks
  • Takes much longer than expected to complete reading assignments

Evidence-Based Interventions

Research from the National Reading Panel (2000) and the Institute of Education Sciences (IES) What Works Clearinghouse has established that effective reading intervention must be explicit, systematic, and sequential, targeting five essential components: phonemic awareness, phonics, fluency, vocabulary, and comprehension.

  • Structured Literacy / Orton-Gillingham Approach: A multisensory, structured, sequential method of teaching reading that integrates visual, auditory, and kinesthetic-tactile pathways. Multiple studies have demonstrated its effectiveness for students with reading disabilities (International Dyslexia Association, 2019).
  • Wilson Reading System: Based on Orton-Gillingham principles, Wilson provides a highly structured 12-step program for students who require intensive decoding and encoding instruction. It is listed as an evidence-based intervention by the IES What Works Clearinghouse.
  • Lindamood-Bell Programs: Programs such as Seeing Stars (for symbol imagery and sight word development) and Visualizing and Verbalizing (for reading comprehension) target the sensory-cognitive processes underlying reading. Research supports their use for improving phonological awareness and comprehension.
  • Structured Literacy: The International Dyslexia Association recommends structured literacy as the overarching instructional framework that encompasses systematic phonics, morphology, syntax, and semantics — delivered explicitly and cumulatively.

What Teachers Can Do

  • Provide explicit, systematic phonics instruction using a structured literacy approach
  • Allow extended time for reading assignments and assessments
  • Pair written text with audiobooks or text-to-speech technology
  • Pre-teach vocabulary and provide graphic organizers before reading
  • Avoid round-robin reading; offer alternative ways to demonstrate comprehension
  • Provide frequent, positive feedback to build confidence and persistence

What Parents Can Do

  • Read aloud to your child regularly — this builds vocabulary and a love of stories regardless of reading level
  • Use audiobooks to maintain engagement with age-appropriate content
  • Celebrate effort and progress, not just accuracy
  • Advocate for evidence-based reading intervention at school (structured literacy approaches)
  • Create a low-pressure reading environment at home — let your child choose what to read
  • Seek an evaluation if you suspect difficulties — early intervention produces the strongest outcomes

References: National Reading Panel (2000). Teaching Children to Read: An Evidence-Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction. National Institute of Child Health and Human Development. | International Dyslexia Association (2019). Structured Literacy: Effective Instruction for Students with Dyslexia and Related Reading Difficulties. | IES What Works Clearinghouse, U.S. Department of Education.

Clinical Definition

A Specific Learning Disability in Math is characterized by persistent difficulties in number sense, memorization of arithmetic facts, accurate or fluent calculation, and/or accurate math reasoning. The DSM-5-TR identifies these challenges under the umbrella of Specific Learning Disorder with impairment in mathematics. In clinical and research literature, the term dyscalculia is sometimes used to describe severe and specific difficulties with number processing and arithmetic. However, in educational settings under IDEA, the federal classification is Specific Learning Disability in the area of Mathematics Calculation and/or Mathematics Problem Solving.

How It Appears at School

  • Difficulty understanding number magnitude and number relationships (e.g., which number is larger, number line concepts)
  • Persistent trouble memorizing basic math facts despite repeated practice
  • Reliance on finger counting or other concrete strategies well beyond the age when peers have moved to mental math
  • Confusion with math symbols and operations (e.g., mixing up + and ×)
  • Difficulty with multi-step word problems, especially translating language into mathematical operations
  • Struggles with telling time, understanding money, and measurement concepts
  • Inconsistent performance — may solve a problem correctly one day and be unable to do it the next

How It Appears at Home

  • Anxiety or frustration around math homework that exceeds reactions to other subjects
  • Difficulty with everyday math tasks like making change, reading clocks, or estimating quantities
  • Avoidance of board games or activities that involve counting or keeping score
  • Trouble following sequential steps in recipes, building instructions, or other ordered tasks
  • May need significantly more time than siblings or peers for the same math assignments

Evidence-Based Interventions

  • Concrete-Representational-Abstract (CRA) Approach: This instructional sequence, supported by research from the National Council of Teachers of Mathematics and the IES Practice Guide for math interventions, moves students through three stages: using physical manipulatives (concrete), then visual representations such as drawings or diagrams (representational), then abstract numbers and symbols. The CRA approach has been shown to significantly improve math outcomes for students with learning disabilities (Witzel, Mercer, & Miller, 2003).
  • Number Sense Interventions: Programs that build foundational number sense — including subitizing, magnitude comparison, and mental number line representation — have been shown to improve math performance in students with math disabilities (Jordan et al., 2009).
  • Explicit Instruction with Guided Practice: The IES Practice Guide Assisting Students Struggling with Mathematics (2009) recommends explicit, systematic instruction that includes modeling, guided practice, and immediate corrective feedback for students with math difficulties.
  • Self-Monitoring Strategies: Teaching students to check their work using estimation and self-questioning techniques improves accuracy and independence.

What Teachers Can Do

  • Use the CRA sequence to introduce new concepts (start with manipulatives, then pictures, then numbers)
  • Provide a multiplication chart or fact reference sheet to reduce memory load
  • Use graph paper to help with alignment of numbers in calculations
  • Break multi-step problems into smaller, clearly defined steps
  • Allow use of a calculator for higher-order problems when computation is not the target skill
  • Provide extra time and reduce the number of practice problems while maintaining rigor

What Parents Can Do

  • Use everyday activities to practice math: cooking (measuring), shopping (estimating costs), building projects (counting and measuring)
  • Play math-related games (card games, dice games, dominoes) to build number sense in low-pressure contexts
  • Avoid timed math fact drills, which can increase anxiety — use spaced practice instead
  • Use visual and hands-on materials when helping with homework
  • Focus on understanding concepts rather than memorizing procedures
  • Recognize math anxiety as real and valid — provide emotional support alongside academic support

References: Witzel, B. S., Mercer, C. D., & Miller, M. D. (2003). Teaching algebra to students with learning difficulties: An investigation of an explicit instruction model. Learning Disabilities Research & Practice, 18(2), 121–131. | Jordan, N. C., et al. (2009). Early math matters: Kindergarten number competence and later mathematics outcomes. Developmental Psychology, 45(3), 850–867. | Gersten, R., et al. (2009). Assisting Students Struggling with Mathematics: Response to Intervention (RtI) for Elementary and Middle Schools. IES Practice Guide, NCEE 2009-4060.

Clinical Definition

A Specific Learning Disability in Written Language (sometimes referred to in clinical literature as dysgraphia) is characterized by persistent difficulties in spelling accuracy, grammar and punctuation accuracy, and/or clarity and organization of written expression. The DSM-5-TR classifies this under Specific Learning Disorder with impairment in written expression. Writing is a complex skill that requires the integration of multiple cognitive processes simultaneously — including language formulation, fine motor control, working memory, and executive functioning — which is why writing disabilities are sometimes the most impactful on a student's day-to-day school performance.

How It Appears at School

  • Written work is significantly below the quality of the student's oral expression and ideas
  • Illegible or inconsistent handwriting, difficulty with letter formation and spacing
  • Frequent spelling errors, even for words the student can read or say correctly
  • Difficulty organizing thoughts on paper — writing may lack logical sequence or paragraph structure
  • Avoidance of writing tasks; may produce minimal written output despite having extensive knowledge
  • Extremely slow writing speed, leading to incomplete classwork and tests
  • Difficulty with note-taking during class instruction

How It Appears at Home

  • Homework involving writing takes disproportionately long and causes significant frustration
  • May dictate brilliant ideas but cannot get them on paper independently
  • Avoids writing thank-you notes, journal entries, or other age-appropriate writing tasks
  • Physical complaints related to writing (hand fatigue, pain) even after brief writing periods
  • Creative and thoughtful in conversation but written work does not reflect the child's true capability

Evidence-Based Interventions

  • Self-Regulated Strategy Development (SRSD): Developed by researchers Steve Graham and Karen Harris, SRSD is one of the most extensively studied and validated approaches for improving writing in students with learning disabilities. It explicitly teaches planning, drafting, and revision strategies, along with self-monitoring and self-reinforcement. Meta-analyses have shown large effect sizes for SRSD interventions (Graham & Harris, 2003; Graham et al., 2012).
  • Assistive Technology: Speech-to-text software (voice dictation), word prediction programs, graphic organizer software, and keyboarding can bypass handwriting difficulties and allow students to focus on content generation and organization.
  • Explicit Handwriting and Keyboarding Instruction: For students with motor-based writing difficulties, direct instruction in handwriting (e.g., Handwriting Without Tears) or keyboarding can improve legibility and writing fluency (Berninger et al., 2006).
  • Graphic Organizers and Structured Templates: Visual planning tools help students organize ideas before writing and reduce the cognitive load of simultaneous planning and writing.

What Teachers Can Do

  • Separate the grading of content from the grading of mechanics (spelling, handwriting) when appropriate
  • Provide graphic organizers and structured writing templates
  • Allow alternative methods of demonstrating knowledge (oral reports, audio recordings, multimedia presentations)
  • Permit use of a laptop or tablet for written assignments
  • Reduce copying demands — provide printed notes or outlines
  • Teach writing strategies explicitly using the SRSD framework

What Parents Can Do

  • Encourage your child to dictate ideas first, then work on getting them written down
  • Provide access to speech-to-text tools for homework (built into most devices)
  • Focus praise on content and ideas, not on neatness of handwriting
  • Consider an occupational therapy evaluation if fine motor difficulties are significant
  • Support keyboarding skills development early
  • Advocate for writing accommodations at school, such as extended time and access to technology

References: Graham, S., & Harris, K. R. (2003). Students with learning disabilities and the process of writing: A meta-analysis of SRSD studies. In H. L. Swanson, K. R. Harris, & S. Graham (Eds.), Handbook of Learning Disabilities (pp. 323–344). Guilford Press. | Graham, S., et al. (2012). Teaching writing to middle school students: A national survey. Reading and Writing, 25(5), 1015–1042. | Berninger, V. W., et al. (2006). Early development of language by hand: Composing, reading, listening, and speaking connections. Developmental Neuropsychology, 29(1), 61–92.

Executive functions are the cognitive processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks. The Harvard Center on the Developing Child describes executive functioning as an "air traffic control system" in the brain — managing the flow of information, prioritizing tasks, and filtering distractions. These skills are not innate; they develop gradually from infancy through the mid-twenties, with the most rapid development occurring in early childhood and adolescence.

Developmental Context

Executive functioning skills develop on a long trajectory. The prefrontal cortex — the brain region most associated with executive functions — is one of the last areas to fully mature, continuing to develop into the mid-twenties. This means that children and adolescents are still building these skills, and difficulties may reflect developmental delays rather than permanent deficits. With appropriate support and scaffolding, executive functioning skills can be strengthened at any age.

Three core executive functions serve as the foundation for more complex skills (Diamond, 2013):

  • Working Memory: The ability to hold information in mind and use it — like remembering multi-step directions while carrying them out
  • Inhibitory Control: The ability to resist impulses, stay focused, and think before acting
  • Cognitive Flexibility: The ability to shift thinking, adjust to changing demands, and see things from different perspectives

These three core skills combine and build upon each other to support higher-order executive functions such as planning, organization, time management, emotional regulation, and goal-directed persistence.

Evidence-Based Programs

  • SMARTS Executive Function Curriculum: Developed at the Research Institute for Learning and Development, SMARTS is a research-based curriculum that teaches executive function strategies explicitly to students in grades 3–12. It includes lessons on self-understanding, goal setting, cognitive flexibility, organizing, prioritizing, and self-monitoring (Meltzer, 2010).
  • Unstuck and On Target: Developed at Children's National Medical Center, this evidence-based intervention targets flexibility, goal-setting, and planning skills. Research has demonstrated its effectiveness for children with autism spectrum disorder and ADHD (Kenworthy et al., 2014).
  • Zones of Regulation: Created by occupational therapist Leah Kuypers, this framework teaches students to identify their emotional and alertness states, understand how these states affect behavior and learning, and use strategies to regulate themselves. It is widely used in school settings from early childhood through high school.

How Executive Functioning Challenges Present in the Classroom

  • Difficulty starting tasks independently, especially open-ended assignments
  • Losing materials, forgetting assignments, and missing deadlines
  • Messy desk, backpack, and binder; difficulty maintaining organizational systems
  • Trouble transitioning between activities or subjects
  • Appearing to "not listen" or "not care" — when the real issue is working memory or attention regulation
  • Difficulty with long-term projects that require planning and pacing work over time
  • Strong knowledge of a subject but poor test performance due to difficulty studying effectively

What Teachers Can Do

  • Provide visual schedules and post daily agendas where students can see them
  • Break long assignments into smaller, clearly defined chunks with individual due dates
  • Teach organizational strategies explicitly — do not assume students will develop them on their own
  • Use checklists for multi-step tasks and routines
  • Provide transition warnings ("We're switching to math in 5 minutes")
  • Allow students to use planners, apps, or visual timers to manage time
  • Offer structured templates for note-taking and written work
  • Check in privately with students to help them prioritize and plan their work

Classroom Accommodations

  • Preferential seating to reduce distractions
  • Extended time on assignments and assessments
  • Reduced assignment length without reducing rigor
  • Written instructions provided in addition to verbal directions
  • Home-school communication system (daily or weekly check-in sheet)
  • Access to a second set of textbooks at home

How Executive Functioning Challenges Look at Home

  • Difficulty following through on chores or routines without repeated reminders
  • Trouble getting ready for school in the morning — loses track of steps, gets distracted
  • Homework battles: difficulty starting, staying focused, or knowing what is due
  • Bedroom and personal spaces are chronically disorganized
  • Difficulty managing time — always seems to be rushing or running late
  • Emotional outbursts when plans change unexpectedly or when frustrated by tasks
  • Knows what to do but struggles to actually do it consistently

What Parents Can Do

  • Establish predictable daily routines with visual schedules posted in key locations
  • Use checklists for morning, homework, and bedtime routines
  • Create a consistent, distraction-reduced homework space
  • Help your child break large tasks into smaller steps — work alongside them at first, then gradually increase independence
  • Use timers to build time awareness ("Let's see if you can finish this step in 10 minutes")
  • Practice "body doubling" — working alongside your child so they have the supportive presence needed to stay on task
  • Validate frustration while maintaining clear expectations
  • Avoid lecturing — use brief, concrete prompts and visual reminders instead

References: Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. | Harvard University Center on the Developing Child (2011). Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function. Working Paper No. 11. | Meltzer, L. (2010). Promoting Executive Function in the Classroom. Guilford Press. | Kenworthy, L., et al. (2014). Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry, 55(4), 374–383.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. According to the DSM-5-TR, ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Symptoms must be present before age 12, occur in two or more settings (e.g., home and school), and interfere with the quality of social, academic, or occupational functioning.

Prevalence

According to the CDC's 2022 National Survey of Children's Health, approximately 11.4% of children ages 3–17 in the United States (approximately 7.1 million children) have ever received a diagnosis of ADHD. Boys are diagnosed more frequently than girls, though research increasingly suggests that girls with ADHD — particularly those with the Predominantly Inattentive presentation — are underidentified because their symptoms are less disruptive and more internalized.

Three Presentations

Predominantly Inattentive

Difficulty sustaining attention, following through on tasks, organizing activities, and avoiding careless mistakes. Often described as "daydreamy" or "spacey." This presentation is frequently missed because the child is not disruptive in class.

Predominantly Hyperactive-Impulsive

Excessive fidgeting, difficulty staying seated, running or climbing in inappropriate situations, talking excessively, and difficulty waiting turns. More often identified early because symptoms are visible and disruptive.

Combined

Meets criteria for both inattentive and hyperactive-impulsive presentations. This is the most commonly diagnosed presentation and often presents the greatest challenge across settings.

Brief Neuroscience Overview

ADHD involves differences in the brain's dopamine and norepinephrine systems, particularly in the prefrontal cortex and its connections to the basal ganglia and cerebellum. Neuroimaging research has consistently shown differences in brain structure and function in individuals with ADHD, including slightly smaller prefrontal cortex volume and differences in brain network connectivity. These biological differences explain why ADHD is not about "trying harder" — it is a difference in how the brain regulates attention, impulse control, and arousal.

The MTA Study

The Multimodal Treatment Study of Children with ADHD (MTA Study), funded by the National Institute of Mental Health, is the largest and longest randomized clinical trial for ADHD treatment. Key findings from the initial 14-month study (MTA Cooperative Group, 1999) showed that carefully managed medication was more effective than behavioral treatment alone for core ADHD symptoms, while combined treatment (medication plus behavioral intervention) produced the best outcomes for associated problems such as oppositional behavior, parent-child relationships, and social skills. Follow-up studies have emphasized the importance of ongoing, individualized treatment planning and the role of behavioral strategies for long-term functional outcomes.

How ADHD Presents in the Classroom

  • Difficulty staying on task during independent work, especially for tasks that are not intrinsically motivating
  • Frequently loses or forgets materials, assignments, and personal items
  • Calls out answers, interrupts, or has difficulty waiting to be called on
  • Difficulty following multi-step directions; needs instructions repeated
  • Fidgets, squirms, taps, or leaves seat frequently
  • Inconsistent performance — may do well on some days and poorly on others, leading to the misperception of "laziness"
  • May hyperfocus on high-interest activities while struggling to attend to required tasks

Accommodations and Interventions

  • Preferential seating near instruction and away from distractions (windows, doors, high-traffic areas)
  • Provide written and visual instructions alongside verbal directions
  • Break tasks into smaller segments with check-in points
  • Use a daily behavior report card (DBRC) to provide structured, positive feedback
  • Allow movement breaks or fidget tools (with clear expectations for use)
  • Extended time on tests and assignments
  • Use proximity and private cues rather than public correction
  • Provide advance notice of transitions and schedule changes

How ADHD Presents at Home

  • Difficulty following through on household responsibilities without multiple reminders
  • Conflict over homework completion, screen time limits, and daily routines
  • Emotional reactivity — quick to anger, difficulty calming down once upset
  • Trouble with time management — often underestimates how long tasks will take
  • Difficulty with sleep onset — busy mind at bedtime is common
  • May seem to "tune out" during conversations or family discussions
  • Risk-taking behaviors, especially in adolescence

Behavioral Parent Training Programs

Research supports several structured parent training programs for families of children with ADHD:

  • Parent-Child Interaction Therapy (PCIT): A live-coached intervention for families with children ages 2–7 that strengthens the parent-child relationship and teaches consistent behavior management strategies.
  • The Incredible Years: An evidence-based program that teaches positive parenting strategies, problem-solving, and emotional regulation for children ages 3–12.
  • Triple P (Positive Parenting Program): A multi-level system of parenting support that has been shown to reduce behavioral problems and improve parent confidence.

Home Strategies and Routines

  • Establish consistent daily routines with visual schedules
  • Keep rules clear, simple, and posted
  • Use immediate, specific praise for desired behaviors ("I noticed you started your homework right when you sat down — great job")
  • Create a calm, structured homework environment with a clear start time
  • Use reward systems based on effort and behavior rather than outcomes
  • Reduce clutter and create designated spaces for belongings
  • Maintain a calming bedtime routine — reduce screens 30–60 minutes before sleep
  • Take care of yourself as a parent — ADHD can be exhausting for the whole family

References: American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). | Centers for Disease Control and Prevention (2022). Data and Statistics About ADHD. National Survey of Children's Health. | MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086. | Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.). Guilford Press.

What Is a Concussion?

A concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head — or by a hit to the body that causes the brain to move rapidly inside the skull. The CDC estimates that approximately 2.5 million emergency department visits, hospitalizations, and deaths in the U.S. are related to traumatic brain injuries each year, with children and adolescents among the most commonly affected groups. A concussion is called "mild" because it is not usually life-threatening — but the effects on a child's thinking, learning, and emotional functioning can be significant and should always be taken seriously.

Signs and Symptoms in Children

Symptoms typically appear within hours to days after injury and may include:

  • Physical: Headache, dizziness, nausea or vomiting, balance problems, sensitivity to light and noise, fatigue, blurred or double vision
  • Cognitive: Difficulty concentrating, memory problems, feeling "foggy" or "slowed down," confusion, difficulty learning new information
  • Emotional: Irritability, sadness, increased anxiety, mood swings, feeling more emotional than usual
  • Sleep: Sleeping more or less than usual, difficulty falling asleep, drowsiness

In young children who cannot articulate their symptoms clearly, caregivers may notice changes in eating or nursing patterns, persistent crying or irritability, loss of interest in favorite activities, unsteady walking, or changes in sleep patterns.

Assessment Tools

Several validated tools are used to assess and monitor concussion symptoms in children:

ACE Evidence-Based

Acute Concussion Evaluation — developed by the CDC as a clinical tool for healthcare providers to systematically assess concussion symptoms, risk factors, and red flags requiring immediate medical attention.

PCSI Evidence-Based

Post-Concussion Symptom Inventory — a validated self-report measure with age-appropriate versions for children (5–7, 8–12, 13–18) and a parent report form to track symptom severity and recovery over time.

BRIEF-2 Evidence-Based

Behavior Rating Inventory of Executive Function, Second Edition — a standardized questionnaire completed by parents and teachers that assesses executive functioning changes that may result from concussion, including working memory, planning, and emotional regulation.

SCAT6 / Child SCAT6 Evidence-Based

Sport Concussion Assessment Tool, 6th Edition — the most widely used standardized sideline and clinical assessment tool for concussion, developed by the Concussion in Sport Group. The Child SCAT6 is designed for children ages 5–12.

ImPACT Testing Evidence-Based

Immediate Post-Concussion Assessment and Cognitive Testing — a computerized neurocognitive test used to evaluate memory, attention, processing speed, and reaction time. Baseline testing before injury allows comparison to post-injury performance to guide return-to-play and return-to-learn decisions.

Apps and Digital Tools

Several apps have been developed to support concussion management and monitoring in children and adolescents:

  • CDC HEADS UP: A free app from the CDC with concussion recognition information, symptom checklists, and return-to-activity guidance for coaches, parents, and healthcare providers.
  • Concussion Coach: Developed by the VA and DoD, this app helps individuals track symptoms, set recovery goals, and access coping strategies.
  • SuperBetter: A resilience-building app with evidence-based activities designed to support recovery from concussion and other health challenges.

Recovery and Return-to-School Considerations

The 2023 Concussion in Sport Group Consensus Statement (Amsterdam) emphasizes a gradual, step-wise return to cognitive activity. For children, this means a structured Return-to-Learn protocol should be implemented before full Return-to-Play:

  • Stage 1: Symptom-limited activity — daily activities that do not provoke symptoms, including reduced screen time and cognitive rest
  • Stage 2: School activities — gradual return with accommodations such as reduced workload, extended time, rest breaks, and a quiet environment for tests
  • Stage 3: Return to part-time school — gradually increase academic load as tolerated
  • Stage 4: Return to full-time school — full academic participation with accommodations as needed
  • Stage 5: Full return to school — no accommodations needed

Important Note

Every concussion is unique, and recovery timelines vary. While most children recover within 2–4 weeks, some may experience prolonged symptoms. Any child whose symptoms persist beyond 4 weeks should be referred for a comprehensive evaluation by a specialist experienced in pediatric concussion management. Schools should have a concussion management team in place that includes administrators, school nurses, school psychologists, guidance counselors, and teachers.

References: Centers for Disease Control and Prevention (2023). HEADS UP to Health Care Providers: Tools for Providers. | Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport (Amsterdam, 2022). British Journal of Sports Medicine, 57(11), 695–711. | Gioia, G. A., et al. (2008). Acute Concussion Evaluation (ACE): Physician/clinician office version. CDC. | Sady, M. D., et al. (2011). School and the concussed youth: Recommendations for concussion education and management. Physical Medicine and Rehabilitation Clinics, 22(4), 701–719.

An estimated 25–30% of school-age children in the United States have a chronic health condition, and approximately 10–15% of those conditions are severe enough to significantly affect school attendance, stamina, concentration, and academic performance (Perrin et al., 2007). When a child is managing a medical challenge, the impact on learning extends far beyond missed school days — it affects cognitive functioning, emotional well-being, social relationships, and the child's sense of identity as a learner.

How Medical Challenges Affect Learning

  • Chronic Illness: Conditions such as asthma, epilepsy, diabetes, sickle cell disease, juvenile arthritis, cancer, and autoimmune disorders can cause fatigue, pain, and cognitive fluctuations that make consistent school performance difficult. Children may be physically present but unable to learn effectively due to the physiological effects of their condition.
  • Medications: Many medications used to treat childhood conditions have cognitive and behavioral side effects. Anticonvulsants may affect processing speed and memory; corticosteroids can cause mood changes and difficulty concentrating; chemotherapy agents can have lasting effects on attention and executive functioning (known as "chemo brain").
  • Hospitalizations and Medical Procedures: Extended or repeated hospitalizations cause gaps in instruction, social isolation from peers, and anxiety about returning to school. Medical trauma can affect a child's emotional availability for learning even after they have physically recovered.
  • Fatigue and Stamina: Many medical conditions cause chronic fatigue that is invisible to others but profoundly affects a child's ability to sustain attention, complete work, and participate in a full school day.

Common Medical Conditions That Impact Education

  • Epilepsy and seizure disorders — can affect memory, processing speed, and attention
  • Childhood cancer and post-treatment effects — long-term cognitive effects of treatment
  • Type 1 diabetes — blood sugar fluctuations affect concentration and mood
  • Severe allergies and asthma — medication effects, anxiety about attacks, missed school
  • Autoimmune conditions (e.g., lupus, Crohn's disease) — unpredictable symptom flares
  • Sickle cell disease — pain crises, fatigue, and missed school days
  • Chronic pain conditions — difficulty sitting, concentrating, and maintaining stamina
  • Congenital heart disease — fatigue, reduced stamina, surgical recovery periods

Section 504 Plans and Medical Accommodations

Under Section 504 of the Rehabilitation Act of 1973, students with medical conditions that substantially limit one or more major life activities (including learning, concentrating, reading, and thinking) are entitled to reasonable accommodations to ensure equal access to education. A 504 Plan does not require the student to qualify for special education under IDEA — it requires documentation of a medical condition that affects school functioning.

Common 504 accommodations for students with medical conditions include:

  • Flexible attendance policies with a plan for making up missed work
  • Modified schedule (shortened day, late start, rest periods)
  • Extended time on assignments and assessments
  • Permission to eat, drink, or take medication as needed during the school day
  • Access to the nurse's office without restriction
  • Homebound instruction during extended absences
  • Reduced homework load during active treatment or symptom flares

What Teachers Can Do

  • Educate yourself about the student's condition — ask the family and school nurse what you need to know
  • Recognize that inconsistent performance is a feature of the medical condition, not a behavioral choice
  • Maintain high expectations while providing flexible pathways to meet them
  • Develop a re-entry plan for students returning from extended absences
  • Prioritize essential learning — identify "must-do" vs. "can-skip" assignments during difficult periods
  • Communicate regularly with parents about what the student is covering in class
  • Be a trusted adult the student can approach when they need a break or help

What Parents Can Do

  • Provide the school with written medical documentation and recommended accommodations from your child's medical team
  • Request a 504 Plan meeting if your child's medical condition is affecting school performance
  • Keep open communication with teachers — brief, regular updates help more than occasional lengthy conversations
  • Ask your child's medical team about potential cognitive and educational side effects of treatments
  • Help your child maintain social connections with peers during absences (video calls, visits)
  • Monitor your child's emotional well-being — medical challenges take an emotional toll that affects learning readiness

Collaboration with Medical Providers

Effective support for students with medical conditions requires collaboration between families, schools, and healthcare providers. With parent consent, a school psychologist or school nurse can communicate directly with the child's medical team to ensure that academic accommodations are aligned with medical recommendations. This collaboration is especially important during transitions — such as returning to school after a hospitalization, adjusting medications, or managing a new diagnosis — when the child's needs may be changing rapidly.

References: Perrin, J. M., Bloom, S. R., & Gortmaker, S. L. (2007). The increase of childhood chronic conditions in the United States. JAMA, 297(24), 2755–2759. | U.S. Department of Education, Office for Civil Rights (2015). Protecting Students with Disabilities: Frequently Asked Questions About Section 504 and the Education of Children with Disabilities. | Shaw, S. R., & McCabe, P. C. (2008). Hospital-to-school transition for children with chronic illness: Meeting the new challenges of an paletteed practice. Psychology in the Schools, 45(1), 74–87.

Social-emotional well-being is foundational to learning. Research in developmental psychology and education consistently demonstrates that children who are struggling emotionally are less available for academic instruction — their cognitive resources are being directed toward managing distress rather than absorbing new information. The Collaborative for Academic, Social, and Emotional Learning (CASEL) has documented that social-emotional skills and academic achievement are deeply intertwined; difficulties in one area frequently affect the other.

How Social-Emotional Challenges Impact Learning

When a child is experiencing anxiety, sadness, peer conflict, or family stress, the brain's threat detection system (the amygdala) is highly activated. This activation comes at the expense of the prefrontal cortex — the part of the brain responsible for attention, working memory, planning, and reasoning. In practical terms, this means that a child who is emotionally distressed may be unable to concentrate, remember what was taught, organize their work, or regulate their behavior — even though they are intellectually capable and want to succeed.

Common Social-Emotional Challenges

Anxiety

Anxiety disorders are the most common mental health condition in children and adolescents, affecting approximately 9.4% of children ages 3–17 (CDC, 2023). In the classroom, anxiety can look like perfectionism (refusing to start work for fear of making mistakes), test anxiety, school refusal, frequent somatic complaints (stomach aches, headaches), avoidance of participation, and difficulty with transitions or new situations. A child who raises their hand to give answers at home but freezes at school may be experiencing significant anxiety.

Depression

Depression in children may present differently than in adults. Rather than appearing "sad," children with depression may show persistent irritability, loss of interest in activities they previously enjoyed, social withdrawal, declining grades, difficulty concentrating, changes in appetite or sleep, fatigue, and expressions of worthlessness or excessive guilt. Approximately 4.4% of children ages 3–17 have a current diagnosis of depression (CDC, 2023). Depression significantly impacts motivation, cognitive speed, working memory, and the ability to engage in learning.

Peer Difficulties

Peer rejection, bullying, social isolation, and difficulty making or keeping friends can profoundly affect a child's sense of belonging at school — which is a prerequisite for learning. A child who is preoccupied with social survival during recess, lunch, or group work has less cognitive energy available for academics. Peer difficulties are especially common for children with ADHD, learning disabilities, or autism spectrum disorder, who may struggle with the social skills that come more naturally to their peers.

Self-Regulation Challenges

Self-regulation encompasses the ability to manage emotions, behavior, and attention in service of goals. Children with self-regulation difficulties may have frequent emotional outbursts, difficulty recovering from frustration, trouble sitting still, impulsive behavior, and difficulty adapting to changes in routine. These challenges are often misinterpreted as defiance or misbehavior, but they typically reflect an underdeveloped skill set rather than a deliberate choice. Self-regulation develops through the interaction of a child's neurobiology and their experiences with supportive, co-regulating adults.

Family Stressors

Parental divorce or separation, financial instability, domestic conflict, parental mental health challenges, substance abuse in the home, loss of a loved one, housing instability, and other family stressors can create chronic stress that affects a child's neurobiological development and readiness for learning. The Adverse Childhood Experiences (ACEs) research has demonstrated a dose-response relationship between the number of adverse experiences and negative health, behavioral, and academic outcomes (Felitti et al., 1998). Children experiencing family stress may show behavior changes, regression, difficulty trusting adults, and academic decline.

What Teachers Can Do

  • Build a relationship-first classroom where every student feels seen and safe
  • Incorporate social-emotional learning (SEL) into daily instruction — even brief check-ins and community-building activities make a difference
  • Recognize that behavior is communication — look for the need behind the behavior
  • Provide a calm-down space in the classroom where students can self-regulate without shame
  • Use restorative practices rather than purely punitive consequences
  • Refer to the school counselor, school psychologist, or student support team when you notice persistent changes in a student's behavior, mood, or academic performance
  • Maintain predictable routines and clear expectations — structure is calming for children under stress

What Parents Can Do

  • Create time for daily connection — even 10–15 minutes of undivided attention strengthens the parent-child relationship
  • Validate your child's feelings before problem-solving ("That sounds really frustrating" before "Here's what you could try")
  • Model emotional regulation — children learn more from watching how you handle stress than from what you tell them to do
  • Monitor changes in sleep, appetite, mood, and social behavior — these can be early indicators of distress
  • Maintain open communication with the school about significant family changes that may affect your child
  • Seek professional support if your child's emotional difficulties are persistent, worsening, or significantly interfering with daily functioning

When to Seek Additional Support

It is appropriate to seek a professional evaluation or therapeutic support when:

  • Emotional or behavioral difficulties persist for more than two weeks and are not improving
  • The child's functioning at school, at home, or with peers has significantly declined
  • The child expresses persistent feelings of hopelessness, worthlessness, or wanting to die
  • There are significant changes in eating, sleeping, or activity levels
  • The child is refusing to go to school or is experiencing panic attacks
  • Family members feel overwhelmed and unsure how to help

School psychologists, licensed mental health counselors, clinical psychologists, and pediatric psychiatrists are trained to assess and treat social-emotional challenges in children. Early intervention leads to better outcomes — seeking help is a sign of strength and good parenting.

References: Collaborative for Academic, Social, and Emotional Learning (CASEL) (2020). CASEL's SEL Framework. | Centers for Disease Control and Prevention (2023). Data and Statistics on Children's Mental Health. | Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. | Durlak, J. A., et al. (2011). The impact of enhancing students' social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432.