Have you ever asked yourself if your child’s bad marks at school are because of his/her diabetes? Here we present an overview of the possible causes of perceived poor performance, and the latest research findings in this area.

Marie had always been a good student. In year 9, she was found to have diabetes—two weeks before summer break. At that time, she was getting Bs. In year 10, she started to get Ds. 
After his diabetes manifested itself, Paul (14 years old), got his first D in mathematics. Previously, he had always got a B or a C. In French, he received a D, whereas he had never gotten anything below a C before. Could diabetes have been the cause of Marie’s and Paul’s deteriorating performance at school? 

Diabetes, or just a phase?
All children experience phases, with or without diabetes. Within these phases, they are confronted with many challenges that they are expected to overcome. Teenagers find themselves in the position of trying to loosen the close ties with their parents whilst trying to establish their own identities. It can so happen that, in this period, teenagers who were once model students start placing their peers first. School and parents fall to the bottom-most rung of the priority ladder, down amongst the other things that make up the ‘uncool’ category. 
Apart from these age-related changes, moving to a new school or location can negatively influence their performance at school. One has to get used to the new teachers and make new friends. In some cases, the expectations of the new school will be much different and perhaps more demanding than the old one. Luckily, all this represents a phase which, as a rule, should pass with time.

Creating a positive atmosphere
In order to be prepared for these situations, parents should create a positive family environment right from the start. How? By taking time for the children and showing interest in their ideas and emotional worlds; by asking themselves questions as to what the children want, what they would like to do. If it appears that the child is not just going through a phase, professional advice should be sought from, for instance, a psychologist.

Big changes
Normally, after a diagnosis of type 1 diabetes, the child remains in hospital for a period of 14 days. On returning to school, they must work hard to catch up on what has been missed. On top of this, the child must cope with a diagnosis of which the whole family is usually totally unprepared for. Both catching up on missed time, as well as coping with the diabetes, makes it hard to get back on track and maintain previous performance.
Tip: A good parent/child relationship, as well as support and understanding at school, is paramount to good progress—not only for children with diabetes but also for their metabolically sound peers. 

Too many conflicts
There is one group—mostly children and adolescents—that are faced with certain conflicts (i.e, lack of family support, managing illness, etc) that make things particularly difficult for them. These conflicts affect on metabolic control, psychosocial well-being, and performance at school. 
Due to the great stresses involved in trying to treat the diabetes, the child usually has to spend several bouts in hospital, often for lengthy periods of time. This results in many days absent from school. These absences not only affect academic performance, but also the child’s ability to integrate in classroom activities and to make close friends. It often needs the help of a professional to break this type of circle.

What say the researchers?
Several studies have shown that children and adolescents with type 1 diabetes are intellectually as competent as their metabolically sound peers. During and after hypoglycaemia, however, concentration levels tend to drop. Performance should not be tested during these particular times. It is important that the supervisor be informed of the effects of hypoglycaemia before exams, so that if the diabetic student has to take time out to manage a hypoglycaemic episode, s/he can. 

And what about Marie and Paul?
Meanwhile, Marie moved to a different school in year 10, after which she started to regain her footing. She finished her schooling on a B average. Paul realized that his drop in performance was due to his many days of absence. Eventually, he reached B level at maths, but in French he remained on a D. (He tends to think that this is due to his being lazy rather than his diabetes.)  
 

Claudia Ziegler, Dip. Psych.
Kinderkrankenhaus auf der Bult
Hannover
E-mail: ziegler(at)hka(dot)de