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สนับสนุนการจัดทำโดย
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วารสารสมาคมจิตแพทย์แห่งประเทศไทย ปัญหาการเรียนของนักเรียนชั้นประถมศึกษาในกรุงเทพมหานคร กวี สุวรรณกิจ
พ.บ.* Academic Problems in Primary Schools in Bangkok Kavi
Suvarnakich, M.D., S.M. in beh.Sc., M.P.H. * บทคัดย่อ การศึกษาปัญหาการเรียนของนักเรียนชั้นประถมศึกษาจำนวน 1,057 คน จากโรงเรียนในเขตกรุงเทพมหานคร 6 แห่ง โรงเรียนที่เลือกศึกษาครอบคลุมทุกระดับเศรษฐานะของประชากรในพื้นที่กรุงเทพมหานคร นักเรียนถูกระบุว่ามีปัญหาการเรียนโดยใช้ข้อมูลจากแบบสอบถามครูและผู้ปกครอง ประวัติการเรียน ผลการตรวจทางจิตเวชเด็ก ผลการทดสอบทางจิตวิทยา และการศึกษา มีความชุกของปัญหาการเรียนร้อยละ 21.76 เพศชายมีโอกาสเกิดปัญหาการเรียนมากกว่าเพศหญิง มีความชุกของปัญหาการเรียนเฉพาะด้านร้อยละ 6.04 มีความชุกของโรคสมาธิสั้นร้อยละ 2.37 เด็กที่มีปัญหาการเรียนเฉพาะด้านและเด็กที่มีเชาวน์ปัญญาต่ำกว่าปกติจะพบได้บ่อยกว่าในครอบครัวที่มีรายได้น้อย ไม่มีความสัมพันธ์ระหว่างเด็กโรคสมาธิสั้นกับรายได้ของครอบครัว เด็กที่มีปัญหาการเรียนเฉพาะด้านและเด็กที่มีเชาวน์ปัญญาต่ำกว่าปกติมีความสัมพันธ์กับระดับการศึกษาต่ำของผู้ปกครอง ในทางตรงกันข้าม เด็กโรคสมาธิสั้น มีความสัมพันธ์กับระดับการศึกษาสูงของผู้ปกครอง วารสารสมาคมจิตแพทย์แห่งประเทศไทย 2542;44(1): 55-64. คำสำคัญ ปัญหาการเรียน ปัญหาการเรียนเฉพาะด้าน โรคสมาธิสั้น เชาวน์ปัญญาต่ำกว่าปกติ ตัวแปรทางสังคม * ภาควิชาจิตเวชศาสตร์ คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล บางกอกน้อย กรุงเทพฯ 10700 Abstract This survey study was done on 1,057 first graders in 6 schools in Bangkok. Samples were drawn to assure reflection of socioeconomic patterns of Bangkok Metropolitan area. Questionnaires for parents and teachers, and school academic records were used to identify students who had academic problems. Followed by clinical child psychiatric examination, psychological and educational testing and checking. Prevalence of academic problems was found to be 21.76%. Boys showed higher probability of having academic problems than girls. Prevalence of learning disorder (LD) was 6.04%; prevalence of attention deficit hyperactivity disorder (ADHD) was 2.37%. LD and mental subnormality were more likely to be found in students from low income families whereas ADHD seemed to show no definite pattern of association in regards to family income. LD and mental subnormality were associated with low parental education. On the contrary ADHD was found to be associated with high parental education. J Psychiatr Assoc Thailand 1999; 44(1): 55-64. Key words: academic problems, learning disorder, attention deficit hyperactivity disorder, mental subnormality, social variables *Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700. Introduction Our present National Economic and Social Development plans have stressed the improvement of human resources and the undeniable fact is that education is the means to achieve that goal. Even though Thailand could claim literacy rate of more than 90%, the rate of school children going beyond primary education is still very low. There are numerous obstacles besides financial problems and this study is aimed at finding out those obstacles and how they are related to some psychiatric and social variables. The researchers hope that the finding could lead to interdisciplinary programs that could bring about the improvement of learning ability in children that will eventually lead to better quality of human resources at the national level. Material and Method Study population The study population comprised of 1,057 first grade students from 6 schools in Bangkok Metropolitan areas. They were Kosit-samosorn school, Pra-tamnak Suankularb School, Wat Amarinthararam School, Rajini-bon School, St. Gabriel School, and Soon-Ruam-Namchai School. Schools were chosen by purposive sampling method to reassure that socioeconomic distribution pattern in the study sample conform with that of the Bangkok Metropolitan Areas. Students in the whole classes were used in the study Method The study began around the end of the academic year so that there was enough information related to students academic performance to be gathered and ascertained. First step Questionnaires about students learning problems were sent out to parents and teachers. School records on academic achievements for each student were reviewed. Students who were free from being identified as having academic problems by parents and teachers filled questionnaires and were at least average in academic records were label4ed as no academic problem otherwise they would be labeled suspected academic problem and would be subjected to second step investigation. Second step Students with suspected academic problem were interviewed and behaviorally observed individually for more information. School work and home work books were also inspected. All were done by the researching team comprising of a child psychiatrist, psychologists, and educational psychologists. In some cases additional necessary information was obtained by interviewing teachers and parents. Suspected students from step one who were found to be free from academic problems will be grouped with those with no academic problem (from first step). Those who were assured to have academic problems would be subjected to the third step investigations Third step Students who were ascertained to have academic problems from the second step were administered progressive matrices test in small groups for rough estimation of intellectual functioning. Those who scored normal and upward would be labeled "normal intelligent students. Those who scored moderate mental retardation and below would be labeled mental subnormality. Those who scored between dull normal and mild mental retardation would be administered WISC-R test for more accurate intellectual functioning assessment. Afterward they would be grouped with either normal intelligent students or mental subnormality according to their WISC-R Score. Final step Students with normal intelligence who had academic problems were intensively investigated according to their problems which ranged from clinical child psychiatric examination, neurological examination, psychological testing to Mariane Frostig test for visual perception, Bender-gestalt test, etc. Results Total studied population comprising of 1,057 first graders of 512 boys and 545 girls. The number of students who was found to have academic problems was 230 or 21.76%. Of this number 139 were boys and 91 were girls. The rate of academic problems in Boys was 27.1% and the corresponding rate in girls was 16.3%. The ratio of rate in boys: girls was 1.7:1 (or approximately 5:3). This sex difference was found to be statistically significant at the level p<0.001. In this study, the possible causes of academic problems were grouped into 7 categories, and the rate of each category was computed against the number of students with academic problems and the total studied population as shown in Table 1. Table 1 Number and percentage of students by categories of academic problems
Further analysis of each of the category in Table 1 yields the following findings I. Students with neuropsychiatric disorders The combination of category 1 and category 2 from Table 1 when analyzed in details showed the finding as shown in Table 2. Table 2 Students with neuropsychiatric disorders by diagnostic status
Table 2 shows that of 230 students who had academic problems 84 or 36.5% were suffering from neuropsychiatric disorders. Within neuropsychiatric group, 35 of them or 41.67% were Adjustment disorder, 25 or 29.76% were ADHD and 19 or 22% were Anxiety disorder It is interesting to note that for Aspergers Syndrome and ADHD the rate per total study population could be computed and the yielding result could be taken as prevalences. They were 0.09% and 2.37% respectively. Since both disorders were so obvious that parents and teachers would not fail to identify them as having academic problems. The rest of the diagnostic categories did not reflect prevalence since there might be some of the students affiliated with them but have no academic problem. Among 25 of student labeled ADHD, 20 of them were boys and 5 of them were girls. So the rate of ADHD in the boys were 3.9% and 0.9% in the girls which brought the ratio of male: female = 4:1. This sex difference was statistically significant at 0.01>p>0.001 II. Students with learning disorders (LD) This group of students was analyzed by using the combination of category 2 and 3 from Table 1. All of them were found to be dyslexic type. However associated problems were different as shown in Table 3. Table 3 Students with LD by associated problems
Type of LD N. LD Acad. problem Total (N=64) (N=230) (N=1,057) 1. Dyslexia (only) 27 42.19 11.74 2.55 2. Dyslexia with dyscalculria 3 4.69 1.30 0.28 3. Dislexia with articulation problem 3 4.69 1.30 0.28 4. Dyslexia with neuropsychiatric disorder 31 48.44 13.48 2.93 Total 64 100 27.82 6.04 Among 64 students who were suffering from LD, 39 of them were male and 25 were female. The rate in each sex was 7.6% and 4.6% respectively and the sex ratio was 5:3. This sex difference was statistically significant at 0.05> p >0.02. Association between LD and ADHD Analysis from 64 LD students, 15 or 23.44% were found to have ADHD. However when the group of 25 ADHD students was considered, 15 or 60% of them were found to have LD. III. Students who lack motivation for learning There were 12 students who were found to have inadequate motivation for learning. That is 1.14% of the total population or 5.22% of those who have academic problems. There were 8 boys and 4 girls. Percentage-wise in each sex would be 1.56% and 0.73% respectively or the ratio of 2:1. However, this sex difference was not statistically significant. IV. Exceptional childs problems Among 230 students with academic problems, 8 students or 0.76% of all study population were found to have superior intelligence. Boys and girls are equal in number, thus there was no sex difference statistically. V. Students with subnormal intelligence Of total study population, 72 students or 6.81% were found to have subnormal intelligence. However if only borderline mental retardation and mental retardation were considered together, the prevalence rate would be 4.94% Table 4 Number and percentage of students by level of intellectual functioning
N. Pop. with acad. problem Total pop. (N=230) (N=1,057) 1. Dull normal 20 8.69 1.89 2. Borderline mental retardation 5 2.17 0.47 3. Mental retardation 47 20.43 4.47 Total 72 31.29 6.81 Relationship between academic problems and income of the family In this study family income were categorized into 4 groups by the following criteria: monthly income Low income group 5,000 Baht and below Low middle income group 5,001 - 10,000 Baht High middle income group 10,001 - 30,000 Baht High income group 30,001 Baht and up The interesting findings were as follows (Table 5): Table 5 Prevalence of each academic problem by family income (%)
1. ADHD: The difference of prevalence of ADHD in regard to family income was not statistically significant. 2. LD: The difference of prevalence of LD in regard to family income was not statistically significant. However if the low income, low middle income and high middle income are lumped together against the high income group. The correlation between family income and prevalence of LD is in favor of the high income group (low) at statistically significant level (0.05>p>0.02). 3. Mental subnormality: The correlation between family income and prevalence of mental retardation and mental subnormality is in favor of the low income group (low) at statistically significant level (p<0.001). Relationship between academic problems and level of parental education Table 6 Prevalence of each academic problem by parental education (%)
1. ADHD: Association between prevalence of ADHD and level of parental education were found at a Statistical significant level p<0.001. The rates increases as the level of education increases 2. LD: It was found that as the level of parental education decreases the prevalence of LD increases. The association was statistical significant at p<0.05. 3. Mental subnormality: It was found that as the level of parental education increases the prevalence of mental subnormality decreases. This association was found to be statistical significant at p<.001. Relationship between parental occupation and type of academic problems Table 7 Prevalence of each academic problem by parental occupation (%)
1. ADHD: The difference of prevalence in this table is not statistically significant 2. LD: It is interesting to note that the lowest prevalence of LD could be found in children from parents of high level occupation (high rank civil servant, executive, etc.). The highest prevalence were found in children of agricultural worker. The differences in prevalence of LD by parental occupation were found to be statistically significant (0.05>p>.02). 3. Mental subnormality: It is interesting to note that, the highest prevalence was found in children of jobless parents. The above difference is statistically significant (p<0.001). Summary and discussion From the total study sample of 1,057 first graders from 6 primary schools in Bangkok Metropolitan areas the findings could be summarized as follows:- 1. Prevalence of academic problem is 21.76%. Boys to girls ratio is 1.7:1 or approximately 5:3. The sex difference is statistically significant. 2. Among students with academic problems, mental subnormality constitutes the largest portion (31.27%), followed by neuropsychiatric disorders (23.04%), LD (14.35%) and neuropsychiatric disorder with LD (13.48%). 3. Prevalence of Asperger's syndrome is 0.09% 4. Prevalence of LD is 6.04%. Boys to girls ratio is 5:3 and is statistically significant 5. Prevalence of ADHD at the level affecting academic problem is 2.37%. Boys to girls ratio is 4:1 and is statistically significant. 6. Relationship between LD and ADHD revealed that 23.44% of LD have ADHD, and 15.00% of ADHD have LD. 7. Prevalence of student lacking in learning motivation is 1.14%. Boys to girls ratio is 2:1 but not statistically significant. 8. Prevalence of exceptional child with academic problems is 0.76%. There is no sex difference. 9. Prevalence of students with mental subnormality is 6.81% which is the combination of: Dull normal 1.89% Borderline mental retardation 0.47% Mental retardation 4.47% 10. In regard to family income: - ADHD rate was found to have no significant relationship with family income. - LD rate was found to have no significant relationship with family income. However when the low, low middle and high income are grouped together and computed against the high income group. The low prevalence of LD was found to be associated with high family income at a statistically significant level. - Subnormal intelligence was found to be related to family income at a statistical significant level. That is the lower family income is the higher rate of mental subnormality was found. 11. In regard to parental education: - ADHD was found to be related to higher parental education at a statistically significant level. - LD was found to be related to lower parental education at a statistically significant level. - Mental subnormality was found to be related to the lower parental education at a statistically significant level. 12. In regard to parental occupation - ADHD was found to have no relationship with parental occupation - LD was found to have higher rate in agricultural occupation (30.77%), teachers (8.33%), low level civil servants, small business operators, workers (8.14%), but 0% in physician. The differences were found at a statistically significant level - Mental subnormality was founds to have high rate among jobless (42.86%), followed by agricultural worker (15.38%) and low level civil servant (13.68%) but 0% in physician. The difference were found at a statistical significant level. The findings in this study about prevalence rate of academic problem, ADHD, LD, and mental retardation seemed to go along with the findings in other countries. The probability of more boys than girls to be found having academic problems in general, ADHD, and LD; and negative association between LD, subnormal intelligence, and parental income also seemed to be universal. However the association between high prevalence of ADHD and high parental income and education seemed to be unusual, but proper explanation could not be done from the available data. Zero findings of LD and ADHD in students from parents with no education were also unusual. This could perhaps be explained by the possibility that students from parents with no education who had subnormal intelligence might have LD or ADHD or both in coexistence and they were taken as cases of subnormal intelligence and thus had no chances to be identified as LD or ADHD cases. The findings that LD was more prevalence among agricultural workers, low level civil servants, small business operators workers, and teachers and ADHD was more prevalence amongst teachers were interesting and should be further investigated in the future research. Acknowledgement Particular thanks are due to Dr.Taanee Sethajarn, Dr. Titavee Kaowpornsawan, and Dr. Panom Ketuman, Department of Psychiatry, Faculty of Medicine, Siriraj Hospital. Mrs. Nusara Jencharoen also deserves thanks, for her patience typing. Bibliographies
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