It's a situation every parent dreads, but has become all too common: the phone call home from school and the request to come in to discuss little Amy's behavior at school. Maybe it's that she's wiggly in her seat, asks to use the bathroom every time worksheets are handed out, or chats too much with her neighbor. Maybe she's daydreaming, loses her papers, and appears to be "in her own world" too much of the time. But whatever it is, her reading scores are now showing a gap: Amy is falling behind in her performance and is no longer on grade level. What's going on? Ruling Out Other Issues Understanding children's behavior can be complex and maddening. It might seem like as soon as you get a handle on a particular problem, it shapeshifts, leaving you clutching a wisp of smoke and a bunch of solutions that are no longer useful. School-based problems in academic performance and attention or focus can have a wide variety of causes. Taking a systematic series of steps to rule out medical and emotional issues can help you stay organized and focus as you help your child get back on track. \tRule out medical or physical causes of inattention of distress. Seizure disorder, for example, could explain the apparent "in her own world" moments, or serious gaps in learning. \tRule out emotional causes of in-school behaviors. Do a quick review of home life: has anyone in your child's life undergone a significant life change? New little brother or sister in the home? New pet? Separation or divorce, domestic violence, alcohol or substance abuse in a family member, sexual abuse, death of a close relative, or a significant anniversary of any of the above could causes changes in attention and\/or behavior. \tEstablish a good timeline. Was there a time in your child's school career when things were different, or has paying attention or learning always been a bit of a struggle? Figure out when the problems started, and what type of material was being taught at that time, as well as linking home life and events with the onset of the problems. Already Diagnosed? Maybe Josh is already diagnosed with an attention problem \u2013 let's assume he has been diagnosed and is being treated by a psychiatrist for Attention Deficit Hyperactivity Disorder (ADHD). Sometimes while certain behaviors improve in the classroom (and, thankfully, at bedtime), parents will continue to see low grades and poor academic performance, despite a clear improvement in focus, attention, and behavior. What's going on? Co-Morbidity: The Double Whammy Co-morbidity means two or more disorders are present. This is common in both mental health care and substance abuse: often depression and anxiety are co-morbid, and bipolar disorder has a very high rate of co-morbidity with addictions. In the case of ADHD, learning disabilities (LD) are extremely common in people who have been diagnosed with ADHD. A quick survey of the literature offers estimates of between 40% to 70% co-morbidity rates of ADHD and LD. That means even on the low end, a child with ADHD has an almost 50-50 chance of also having a learning disability. ADHD is not a learning disability, but it has a clear impact upon learning. Determining whether or not a child has ADHD should be a cooperative effort, teaming parents, teachers and clinicians up to complete surveys and perhaps administer some tests (such as the computer-based Continuous Performance Test), gathering information that ultimately a clinician will use to make the final diagnosis. Learning disabilities are diagnosed somewhat differently. Psychologists (not medical doctors) are the specialists you want to get involved for this effort. After checking off all the rule outs described above, and starting treatment for ADHD (if diagnosed), if your child is still struggling with academic performance, an evaluation by a psychologist is the next step. A complete educational evaluation should involve hours of a Ph.D. level professional's time. The evaluation consists of psychological tests your child will do, and interviews with you and other caregivers. Sometimes classroom observations are part of the process as well. Most children find the process boring or tedious at worst, but many actually enjoy being tested since receiving one on one attention from a friendly adult is generally positive for most children. In addition, many children who do have ADHD and LD do best in one on one situations with adults and may welcome the opportunity to have a positive experience since school is often so difficult or fraught with criticism and correction. What Next? What happens if a learning disability is diagnosed as well as ADHD? Unfortunately, unlike ADHD, there are no medications that target learning disorders. Helping your child will involve figuring out strategies to compensate for the learning gaps or challenges. Special education teachers are trained to help children in precisely this way: they are taught a wide range of strategies for helping kids use different approaches to learning. For example, some children have tremendous trouble learning when material is presented out loud: auditory processing is very difficult for them. Helping those children utilize other senses (e.g. visual) can help them be successful. Children who have dyslexia (a specific LD) have severe difficulties learning to read; extensive techniques and materials to assist these children exist. The most important way you can help your child is to stay positive and focus on their strengths. Many people with challenges in our area of life have tremendous strengths in others. Balance out the criticism and correction your child receives from school with appropriate, well-earned and fair praise for all the things she does right. It can be very frustrating and difficult for all involved: you, your child, and the school personnel, but ultimately this will be another parenting journey through which both of you will grow. Try to enjoy what you can, maintain perspective, and role model a positive attitude. Your child will thank you for it one day.