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  • Updated 02.26.2023
  • Released 09.02.2015
  • Expires For CME 02.26.2026

Academic underachievement



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 (09; 37). Binet and Simon published their test that identified French students who would require special education (35). In the mid-20th century, descriptions of novel syndromes by Kanner and Kirk, autism and learning disabilities, were respectively defined (15; 26). 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.

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