Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Janet Hafler

Abstract

The estimated prevalence of learning disabilities (LDs) is nearly 8% of all children. Yet fewer than 5% of all children are diagnosed in public schools — jeopardizing remediation. The specific aims of this study were as follows: 1) To perform a qualitative study involving individual interviews with front-line child-facing professionals to identify barriers to detecting school-aged children with LDs and 2) To utilize results to suggest improvements to pediatric clinical care, as pediatricians are often initial responders for families when children experience academic difficulties.

We conducted a qualitative study with individual interviews of 40 professionals from different areas of the United States identified through theoretical sampling (20 educators, 10 pediatricians, and 10 child mental health clinicians). Clinicians represented academic and community settings, and educators represented public, private, and charter schools. Twenty had expertise in assessing LDs; 20 were generalists without specific training. We also endeavored to maximize representation across age, gender, race/ethnicity, and location. We analyzed transcripts utilizing grounded theory and identified themes reflecting barriers to detection.

Themes (and sub-themes) included: 1) areas requiring improved professional education (misconceptions that may hinder detection, confounding factors that may mask LDs, and need for increasing engagement of parents or guardians in identifying LDs) and 2) systemic barriers (time constraints that limited professionals’ ability to advocate for children and to delve into their emotional experiences, inconsistent guidelines across institutions and inconsistent perceptions of professional responsibility for detection, and confusion surrounding screening tools and lack of screening by some professionals in the absence of overt problems).

Clinicians and other child-facing professionals may benefit from augmented training in screening and identification and enhanced evidence-based and institutional guidance. Future quantitative research could investigate whether these efforts could increase efficiency and perceived responsibility for recognition and improve earlier detection.

Comments

This is an Open Access Thesis.

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