The Early Lead Poisoned Child in the Classroom: Symptomatology and Intervention for School Psychologists and School-Based Personnel

By Anne M.W. Winner, NCSP, C.A.S.E.
[LID 436]

Symptomatology

Lead exposure, in early developmental years, even below treatment levels, may produce deficits in:

1. IQ

1. Large scale testing shows mild decrease especially in verbal scores.

2. IQ use in the classroom is almost certainly lowered.

2. ATTENTION

1. Difficulty in focusing and maintaining attention.

2. Slower response time; may lose track if there is a delay between directions and performance.

3. BEHAVIOUR

1. Mild Attention Deficit Disorder (ADD) type behaviour; restless; "itchy’; distractible. Not organised or persistent about tasks.

2. Appears to daydream.

3. Shows inappropriate play behaviour and social interaction. Apt to withdraw.

4. LANGUAGE/AUDITORY

1. Central auditory processing problems with normal pure tone audiological testing.

2. Word finding difficulties

3. Sequencing difficulties.

5. PERCEPTUAL INTEGRATION

1. Spatial discrimination problems.

2. Perceptual-motor integration problems.

1. Inquire about lead exposure at school entrance or special education screenings.

1. Ask about lead levels, treatment and parental follow-up of recommended measures (lead-free housing; cleaning; diet; nursery school).

2. Diagnosis of early low-level lead poisoning can warrant early intervention placements under Federal and/or State laws.

3. All children lead exposed at Centre for Disease Control (CDC) "at risk" levels (10 µg/DL) should have some early intervention measures.

2. In the classroom: In regular or special education classes, the child who shows difficulty should have:

1. Preferential seating: Some children with processing problems may also need direct "attention holding" contact, often from only 3 feet away. (Such children should be referred to special language classes.)

2. Assignment of a Buddy: This helps the child with directions, especially if delay in response is involved.

3. Behaviour Modification Program: Train child to ask for repetition or clarification from teacher or buddy and to maintain attention to task.

4. Referral to Speech/Language Resource: Consultation or direct work on auditory processing and language stimulation.

5. Referral to School Psychologist: Direct intervention to improve play behaviour and social interaction; help child with any emotional problems arising from this condition; and direct classroom activities.

1. LEARN all you can about lead poisoning in children and the resources in your community for handling it.

2. EDUCATE by bringing in speakers for faculty, in-service and PTA meetings to educate school personnel and parents on the subject of early childhood lead poisoning.

3. COOPERATE individually and as a dept:

1. Serving on School Health Committees.

2. Working with other agencies, i.e., Public Health Departments, Clinics, Doctors.

3. Educating teachers to be alert to symptoms and then make appropriate referrals.

4. Developing creative individualised programming for a child.

4. APPOINT a "Lead Poisoning" specialist to be responsible for receiving notification from clinics or doctors, and tracking child through school appropriate referrals may be made in a timely fashion.

A WORD FROM THE EDITOR

If you’re concerned about a school child after reading the article above, then a simple lead test on the child’s shed baby tooth may set your mind at rest or identify a problem and save recriminations.

For some schoolchildren there would be merit in having a blood lead test, but only if the child has some unusual habits eg renovating, making fishing sinkers, sucking toy soldiers, thumb-sucking, nail-biting or pica (eating non-food items).

For a child who was only poisoned as an infant, the blood test result will be normal to low, so only the tooth lead result remains as evidence of the lead poisoning.

Tooth lead analysis

Example of a Report (May 1994):

Description: Deciduous Crown – Upper left central incisor. Sample mass = 0.1915 g.

Result: 22.2 µg/g (ppm)

Comment:

In a study published by H T Delves, Southampton General Hospital, UK (1982) the range of lead in deciduous crowns collected from a control group of children was 1.0 to 26.9 µg/g, with a mean of 4.7 µg/g.

In personal research (1990) involving a study of 221 deciduous crowns collected from children in the Sydney area the range of lead was: 1.7 to 38.2 µg/g, with a mean of 5.4 µg/g.

The frequency distribution of results across this range is skewed, and from the data obtained I would suggest that "normal" values for lead in deciduous crowns range from: 1 to 13.5 µg/g.