There are many reasons for children to underperform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, a poor sociocultural home environment, psychiatric disorders, or even environmental causes.
(1) Medical Problems
These conditions have been reported to have an independent effect resulting in poor school performance.
(a) Preterm birth and low birth weight (LBW): Up to 33% of children born between 32 and 35 weeks gestation and up to 25% of LBW babies (< 2000 g) are at risk for school difficulties into late childhood, even when not neurologically impaired.1,2 Arithmetic, vocabulary, concentration, non-verbal intelligence, and attention problems are significant mediators of the effect of LBW on the school performance score.2,3 Children born preterm, small for gestational age or with very low birth weight (<
1500 g), tend to have the poorest cognitive abilities.3,4
(b) Malnutrition and nutritional deficiencies:
Malnutrition in early childhood is associated with poor cognition in later years and this is independent of psychosocial adversity.5 Chronic iron deficiency anemia, zinc deficiency and inadequate intake of vitamins A, B1,
B2, B6, D3, and E and niacinamide adversely affect longterm cognitive development.6-8
(c) Worm infestations: Infestation with roundworm, hookworm and whipworm often affects malnourished children’s school performance because it can stunt growth, decrease physical activity, and cause poor mental development.9, 10, 11
(d) Hearing impairment: Children with otitis media with effusion and associated conductive loss during the first 4 years of life have been reported to score lower in math and expressive language between kindergarten and second grade.12 Mild sensorial hearing loss affects
(2) Below Average Intelligence
It is well known that intelligence (measured as the