WEDNESDAY, July 27 (HealthDay News) -- Many 'special needs' kids who struggle with medical, emotional or behavioral issues often face tough social and academic troubles in school, a new study suggests.

Tracking the progress of more than 1,450 students in fourth through sixth grades from 34 rural schools, U.S. researchers found that one-third coped with special health care needs such as asthma, chronic pain, attention deficit-hyperactivity disorder (ADHD), learning disabilities, or emotional or behavioral problems.

These children, from three large school districts in Maryland and West Virginia, were also more likely to be bullied or feel socially isolated in their school, and to be more disruptive in class, according to the cross-sectional study, published in the July 25 issue of Pediatrics.

"Health affects school performance," noted study co-author Dr. Christopher B. Forrest, a professor of pediatrics at Children's Hospital of Philadelphia. "Special health care needs have manifold effects on school outcomes that increase the likelihood that these kids are not going to successfully transition to adulthood."

For the study, Forrest and his colleagues obtained survey data from students and their parents, who completed a screening questionnaire measuring long-term health problems that require health services or cause functional problems. Children were classified as having a special health care need if they had a condition lasting at least 12 months and needed interventions such as prescription medication, therapy, counseling or other medical, mental health or educational services.

Additionally, school records were measured for attendance, grades and standardized achievement test scores.

Forrest said the finding that one of every three students had a special need was high -- greater than a 2003 national survey indicating 20 percent of children aged 6 to 17 had such conditions. But he added that some of the problems stemming from chronic conditions do tend to peak in the ages he and his team studied. Boys were twice as likely to have a special health care need as girls, the study found.

But the overall findings from the study were disheartening, Forrest said. Kids with special health care needs "have significant differences in their engagement in school and their school relationships, as well as academic achievement," he said. "It sets up a trajectory for these kids that's highly distressing."

The high proportion of low-income families living in the three districts studied could have contributed to the study results, Forrest noted, because higher-income schools may have more programs in place to help kids adjust to special needs before fourth grade.

"It's not a national study," he said. "Some communities may have better resources than others."

James Wendorf, executive director of the National Center for Learning Disabilities in New York City, praised the study, saying it "looked at the whole child."

"It certainly clarifies that learning disabilities, once again, are shown to have a demonstrable effect on children's achievement in school," Wendorf said. "We know that students with learning disabilities . . . have very distinct social and emotional challenges that can lead them into difficult situations. We also know many of these things intensify as children grow older."

And because the study used a cross-sectional design, Forrest said he was unable to rule out reverse causation -- that children with poor school outcomes may also be more likely to be labeled as having a special health care need.

Because the problems linked to these special needs can't be qualified as only health- or education-related, Forrest also questioned how communities can bring both systems together when each is funded by a separate stream of finances.

"I also believe it's the kind of challenge we're starting to understand in the 21st century," he said. "We have to look at the child as a whole person . . . and recognize that individuals need health systems and education systems to work together."

More information

The American Academy of Child & Adolescent Psychiatry has more about school school services for special needs children.