Academic underachievement

Bruce K Shapiro MD (Dr. Shapiro of the Kennedy Krieger Institute has no relevant financial relationships to disclose.)
Nina Schor MD PhD, editor. (

Dr. Schor of the National Institutes of Health and Deputy Director of the National Institute of Neurological Disorders and Stroke has no relevant financial relationships to disclose.

Originally released September 2, 2015; last updated February 13, 2020; expires February 13, 2023


Academic underachievement is a common presenting symptom of developmental dysfunction in school-aged children. The differential diagnosis is broad and encompasses neurodevelopmental, psychiatric, social, and neurologic disorders. Many of the disorders associated with academic underachievement co-occur. A systematic analysis of the nature of the academic underachievement and a multimodal approach to management may lead to successful outcomes.

Key points


• Academic underachievement is common and affects at least 13% of school children in the United States.


• Academic underachievement has been associated with adverse social, economic, and vocational outcomes.


• There is no universally accepted definition of academic underachievement.


• The differential diagnosis is broad.


• Multimodal treatment programs involving academic interventions/accommodations, parent training, a preventive mental health program, and medication have been associated with successful outcomes.


• Failed treatment programs are often due to overlooking important comorbidities.

Historical note and terminology

The modern focus on academic achievement began in the 19th century with the work of Seguin with children who had intellectual disability. At the turn of the century, descriptions of pathologic hyperactivity and congenital word blindness expanded the spectrum of academic underachievement to children who did not have intellectual disability (Hinshelwood 1917; Still 2006). Binet and Simon published their test that identified French students who would require special education (Siegler 1992). In the mid-20th century, descriptions of novel syndromes by Kanner and Kirk, autism and learning disabilities, were respectively defined (Kanner 1943; Niolon 2014). In 1975, the Education for All Handicapped Children Act guaranteed all children a "free and appropriate" education in the "least restrictive environment." Current advances in pediatric neuropsychology, genetics, epidemiology, and neuroimaging have increased our knowledge of the neurobiology of these disorders.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.

Find out how you can join MedLink Neurology