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The Merck Manual--Second Home Edition logo
 
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Chapter 271. Problems in Adolescents
Topics: Introduction | Delayed Sexual Maturation | Short Stature | Obesity | School Problems | Behavioral Problems | Drug and Substance Use and Abuse | Contraception and Adolescent Pregnancy
 
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School Problems

School constitutes a large part of an adolescent's existence. Difficulties in almost any area of life often manifest as school problems.

School problems during the adolescent years may be the result of rebellion and a need for independence. Less commonly, they may be caused by mental health disorders, such as anxiety or depression. Substance use, abuse, and family conflict also are common contributors to school problems. Sometimes, inappropriate academic placement--particularly in adolescents with a learning disability or mild mental retardation that was not recognized early in life--causes school problems. In general, adolescents with significant school problems should undergo educational testing and a mental health evaluation. Specific problems are treated as needed, and general support and encouragement are provided.

Particular school problems include fear of going to school, truancy, dropping out, and academic underachievement. Problems that developed earlier in childhood, such as attention deficit/hyperactivity disorder (ADHD) and learning disorders (see Section 23, Chapter 269 and Section 23, Chapter 269), may continue to cause school problems for adolescents.

Between 1% and 5% of adolescents develop fear of going to school. This fear may be generalized or related to a particular person (a teacher or another student) or event at school (such as physical education class). The adolescent may develop physical symptoms, such as abdominal pain, or may simply refuse to go to school. School personnel and family members should identify the reason, if any, for the fear and encourage the adolescent to attend school.

Adolescents who are repeatedly truant or drop out of school have made a conscious decision to miss school. These adolescents generally have poor academic achievement and have had little success or satisfaction from school-related activities. They often have engaged in high-risk behaviors, such as having unprotected sex, taking drugs, and engaging in violence. Adolescents at risk for dropping out should be made aware of other educational options, such as vocational training and alternative programs.

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