摘要：Objective: The aim was to perform a retrospective case review of pupils who had not succeeded in elementary school, in order to analyze barriers at individual and system levels. Methods: Forty-five pupils, aged 16–20 years, who had not qualified for senior high school, were consecutively assessed within the school health unit to determine their cognitive function, school history, measures taken, previous assessments, and diagnoses given. Results: School health records revealed early problems with learning, reading, mathematics, and attention, but very few students had received an appropriate diagnosis. Our review and assessment when all the data had been compiled demonstrated that the vast majority (96%) of participants had clear developmental problems. Attention problems or full attention deficit/hyperactivity disorder dominated. About half of the students reported extensive truancy. Mean intelligence quotient in the study group was 83.9, about 1 standard deviation below the mean. Fluid intelligence was significantly superior to crystallized intelligence. Conclusion: Screening and identification are needed throughout the school years of children who present symptoms that could interfere with their academic achievement. Intervention needs to be based on skilled assessment, with consideration given to each individual's broad panorama of cognitive deficits and assets, as well as concomitant social adversities that may underlie their school failure. Since there can be a significant negative impact of limited educational opportunities on future socioeconomic outcomes, the question of who is at risk is important both for affected individuals and more generally for public health. Limitations: The study group was small and may not have been fully representative. In spite of limited confidence about generalizing from the results, the findings call for reflection.
