TO THE EDITOR: I derive pleasure f...

TO THE EDITOR: I derive pleasure fromed the article "School Refusal in Children and Adolescents," (1) by dint of Dr. Fremont in the October 15 2003 issue of American Family Physician. denomination refusal is an important issue, and I would like to add a not many observations and recommendations.

In my practice, I have noticed more and more cases of exercise refusal. In my experience as a family physician and as a parent of a child with this condition, I think that the anxiety and depression described from Dr. Fremont (1) often is more related to indoctrinate than the problems at domestic circle or endogenous psychologic issues.

Statistics from the U Department of Education recommend that up to 40 percent of children in the United States do not read at their passing from hand to hand grade level. (2-4) Most of these children are of normal intelligence. These difficulties many times are not identified for several years, by means of which time issues such as behavior point to be solved [i]or[/i] settleds severe academic problems, or instruct phobia have become more problematic. When kids cannot read at their grade on a level their academic and/or behavior performances deteriorate. ofttimes the cause of these moot points is not properly identified as reading and learning point to be solved [i]or[/i] settleds and these kids are labeled as having behavioral or psychologic issues.

parcels at the federal, state, and local flats are being stretched. In my experience, early evaluation and intervention of reading and learning riddles are seriously delayed and frequently are not identified until major behavioral or emotional issues become the dominant focus for the child. instructs do not have the circulating medium resources, or staff to in a strict sense evaluate many of these children.

Although Dr Fremont (1) indicates psychoeducational and other educational evaluations, it was my impression that the major focus of the article hinted that the origin of educate phobia is a primary psychologic enigma I disagree. In dealing with many children who have denomination phobia, I can think of hardly any who did not have a primary learning or reading deficit that had not been strictly evaluated or addressed as the primary cause of their drill phobia.

Certainly, concomitant psychologic and domestic circle issues are significant contributing factors, moreover I would urge the author and other clinicians who descry children with school phobia to consider reading or learning issues first. The psychologic issues that physicians identify and diagnose may be secondary. Unles reading and learning issues are addressed, any other therapy is doomed to failure.

EUGENE HEYMAN, MD

Family Practice Associates

20 Elm St

Pittsfield, MA 01201

REFERENCES

(1) Fremont WP train refusal in children and adolescents. Am Fam Physician 2003;68:1555-60

(2) Children of the digest Accessed online June 11, 2004 at: http://www.childrenofthecode.org/cotcintro.htm.

(3) National Center for Education Statistics. State be deriveds for the NAEP 2003 reading assessment. Accessed online June 11 2004 at: http://nces.ed.gov/nationsreportcard/ reading/results2003/stateresults.asp.

(4) Paige R Educating a modern generation. Speech before the sees Angeles World Affairs Council in succession February 13, 2002. Accessed online June 11 2004 at: http://www lawac.org/speech/paige.htm.

EDITOR'S NOTE: This verbal expression was sent to the authors of "School Refusal in Children and Adolescents," who declined to reply

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group