Excellence in Examinations

Excellence in Examinations

Dr. Beena Johnson

Behavioural & Developmental Pediatrician.

Senior Consultant, Department of Child Guidance

Baby Memorial Hospital, Kozhikode, Kerala, India.

 Education has very important role in determining the future career of an individual. Many students become anxious and experience significant stress during and prior to examinations. Through professional help, the self-esteem of the students can be increased, study skills we can be improved and we can guide the students towards success in examinations.

  • Ideally, to excel in exams, systematic method of studying should start at the beginning of the academic year.
  • Revise each subject in the best possible way.
  • Notes of the main points should be prepared and reading these notes just prior to exams will help the students to recall the topics easily.
  • Solve previous years’ question papers and sample question papers as many as possible. This will help the students to improve the speed, accuracy and self confidence.
  • For the final revision, self-study will help the students to retain more knowledge in long term memory.

Every year, prior to examination, several students are brought to child guidance clinic for management of exam tension and also for improving the exam performance. The children under stress experience emotional responses related to stress in the form of lack of concentration, forgetfulness, impaired sleep and appetite or physical symptoms related to stress. They need scientific therapy from experts in child guidance. By scientific management of exam stress, the physical symptoms will subside and these children can be guided to write the exams with self confidence.

To Manage Exam Tension

  • Be relaxed
  • Never become anxious prior to exams or in the examination hall
  • Set realistic expectations
  • Never compare yourself with other students
  • Think positively
  • Have a good schedule for completing all the syllabus in the correct time
  • Take a small break after 1 hour of studying

Time Management

Time is very precious. Hence use maximum time in the best possible way to get maximum academic information.

  • Organize yourself
  • Develop study planner
  • Make an academic diary
  • Divide appropriate time for each subjects
  • Focus on one task at a time and avoid multitasking

Improve Memory

  • Mnemonic devices help in remembering facts in a better way.

Mnemonics are clues which help us to associate the information we need to remember, with visual image, sentence or a word.  Name mnemonic, expression mnemonic and image mnemonic help to improve memory.

  • While studying, connect new data to the facts which you already remember
  • Understand the basic idea before reading complex facts.
  • Repeat the facts you have learned and do maximum revisions. This will increase the ability to retain information for longer time.
  • Identify your learning style and understand whether you are a visual learner or auditory learner. Adapt your study method according to your natural style of learning. This will help to get best results in exam.

Through professional guidance, the motivation, self confidence, study skills and life skills of the students can be improved.

                     Best wishes to all students for excellence in examinations

Posted in My medical specialty | Leave a comment

Children and Electronic media

Children and Electronic media


Television, cell phones, computers, video games and web social networks are dominating the media world and majority of children have access to multiple media. The numbers of children joining social networking websites are increasing daily.

Pre School Children

Infants and toddlers understand and learn better from real-life experiences and interactions with parents than they do from television or computers. Research suggests that exposure to television and other electronic media during the first few years of life is associated with inadequate development of communication skills and social skills. Hence children less than two years should not be exposed to electronic media.

School Children

With respect to school children, exposure to age-appropriate educational programs is associated with academic enhancement. The content delivered by electronic media has very important role in the personality development of children.Researchers have found that heavy electronic media use can cause attention problems in children.Evidence also shows that exposure to horror and violence through electronic media can cause emotional problems.

Role of Parents

Parents should monitor the electronic media use of children, in order to maximize the positive effects of media and minimize the negative effects. Parents can select age-appropriate programs for their children. If the child has an urge to use the electronic media excessively or the child has behavioral, emotional as well as learning and language problems, the child should be brought for professional guidance.


Electronic media have become an integral part of life in the twenty-first century. It has profound influence on child health. Experts in child guidance, should assess the child’s level of media exposure and intervene on media-related health risks. Through scientific training by professionals in child guidance, we can prevent the misuse of electronic media among children and lead our children towards a very successful future life.



Posted in My medical specialty | Leave a comment

Attention Deficit Hyperactivity Disorder (ADHD) in Children

The most common behaviour disorder in children is ADHD. The main symptoms are impaired attention and hyperactivity, evident in more than one situation.

The symptoms of inattention are characterized by getting easily distracted by extraneous stimuli, making careless mistakes in school work, having difficulty in maintaining attention even in play activities, often losing things like toys, books, pencils or school bag and even forgetting to do the daily activities.

The symptoms of hyperactivity are often manifested by fidgeting with hands or feet, leaving the seat in classroom while the teacher is taking class, talking excessively and running about excessively.

These children often show impulsive behaviour characterized by blurting out answers, interrupting others during conversation and having difficulty awaiting turn.

Many children with ADHD have associated learning difficulty.

Children with Attention Deficit Hyperactivity Disorder get benefit with Behaviour therapy, Social Skills Training, Remedial Education and Family Therapy.

Posted in My medical specialty | Leave a comment

Relevance of Medical Research


The high quality of medical care provided to patients is built upon the effort of thousands of researchers in the field of medicine. Much more research is needed in future to provide insight into the major health problems. Identifying the health needs and directing researchers into these areas will definitely help to achieve better health for the people all over the world.

Types of research

Medical research can be divided into two general categories – preclinical research and clinical research.

Preclinical research is the key step in the development of new treatment modalities. It is carried out in the laboratory as in-vitro tests to isolate a cell or tissue outside the living organism or as in-vivo tests in living organisms.

Clinical research directly involves a particular person or group of people. It can be patient oriented research, which includes therapies or interventions for disease. The outcomes research seeks to identify the most effective interventions and treatments.

Clinical trials test potential treatments in human volunteers to see whether they should be approved for wider use in the general population. Treatments with acceptable safety profiles are considered for use in clinical trials; which are integral part of new product development and are required by regulatory authorities before a new product is brought to the market.

Steps in Clinical Research

Steps involved in the clinical research process include developing the study concept, preparing the protocol for the study, protecting the participants through clinical and regulatory compliance, implementing and monitoring the study, closing the study, analyzing the data, interpreting the results and communicating the results.

Other Areas of Medical Research

Some other important areas of research are the following:

a) Preventive Medicine Research focuses on promoting health in individuals by detecting illness as early as possible and maximizing the available functions.

b) Epidemiological Research focuses on how disease spreads, the risk factors for disease, the optimal medical solution to diseases and to evaluate how successful a medical treatment has been.

c) Behavioural Health Research focuses on how our behavior affects the health and how illnesses affect our emotions and behavior. This includes research into social factors and life style factors which affect our health.

d) Molecular Biology Research: The two main areas of research in molecular biology are genes and proteins. Gene therapy is the cutting edge field of medicine that potentially offers the most important opportunity to care many serious diseases. Further advances in molecular biology research will certainly help to cure most of the serious diseases of the present generation.

There should be long-term targets for health research. We should create a plan of action for proper research utilization to achieve health care for all. The quality of clinical research can be improved by having multidisciplinary research team, which will help to create links with a wide spectrum of medical disciplines. There should be a multifaceted approach in medical research incorporating a strong commitment to ethics.

Benefits of Medical Research

Research has demonstrated that many diseases can be prevented or managed more effectively through new procedures or therapies. There have been profound developments recently in the field of medicine especially in genetics, molecular biology and imaging techniques. Medical research has led to cures for life threatening disorders and has dramatically improved the quality of life of people. The disease incidence, the mortality rate and levels of disability have come down. Research has enabled health care to become more effective and efficient.

Posted in General | Leave a comment


Academic skills form the foundation upon which a student’s performance at school is assessed. For some children, mastering the basic academic skills create inordinate difficulties. Children with learning disorders exhibit academic difficulties out of proportion to their intellectual capacity. As per the international classification of diseases (ICD 10) by the world Health Organization, learning disorders are termed as specific developmental disorders of scholastic skills (SDDSS).
“My son is not interested in studies. Even if I teach him every lesson today, he forgets it tomorrow. He does not copy the school notes . He is getting very low marks in exams.” This was the problem for which a seventh standard student was brought by his mother to adolescent clinic. On evaluation, this boy was found to have learning disorder. His intelligence was above average but his reading, writing and mathematical skills were very low. He was given remedial education and within six months his academic skills improved. His interest in studies also improved remarkably, after motivational counseling.
In general, learning disorders occur in approximately 10% of school going children. Prevalence as low as 3% to as high as 20.6% have been reported from various parts of the country.

The genetic hypothesis is based on twin studies and family studies. Twin studies have reported high concordance rates of about 100 percent for monozygotic twins and 35 percent for dizygotic twins.
Several studies have found evidence for linkage of phonological awareness and reading skills to particular regions of chromosome 6(phonological awareness) and chromosome 15(word reading)
Genetic predisposition on one hand and psychosocial factors as well as special learning conditions on the other, interact with one another. Genetic, developmental and environmental attributes may contribute to the deficits in learning ability. Children with extremely low birth weight and prematurity are at higher risk for developing learning disorders.
Specific reading disorder
The main feature of this disorder is the specific and significant impairment in the development of reading skills. Reading performance should be significantly below the level expected on the basis of age, general intelligence and school placement. There may also be deficits in reading comprehension.
Specific spelling disorder
The spelling performance of the child should be significantly below the expected level regarding age, general intelligence and school placement. There is specific and significant impairment in the development of spelling skills. Ability to spell orally and to write out words correctly are both affected. It may be associated with grammatical errors, punctuation errors, poor paragraph organization and poor handwriting.
Specific disorder of arithmetical skills
The arithmetical performance should be significantly below what is expected on the basis of age, general intelligence and school placement. The arithmetical difficulties may include failure to understand the basic concepts of arithmetical operations, lack of understanding of mathematical terms or signs, failure to recognize numerical symbol, poor spatial organization of arithmetical calculations, difficulty in properly aligning number and inability to learn mathematical tables satisfactorily.
Mixed disorders of scholastic skills
The reading skills, spelling skills and arithmetical skills are significantly impaired in these students. It includes disorders that meet the criteria of ‘specific disorder of arithmetical skills’ and either ‘specific reading disorder’ or ‘specific spelling disorder’.
Scholastic backwardness causes stress for many students. Parents and teachers are also worried regarding the deterioration in scholastic performance of children. In a society where personal worth and appreciation are gained by measures of academic achievement, learning difficulty becomes a source of significant stress for some students, leading to low self esteem, anxiety and behavioral problems.
Adolescents with learning disorders are at higher risk for social skills difficulties , expressive and receptive language disorders, attentional problems, anxiety, behavior disorders and depressive disorders. Up to 25% of students with reading disorder are found to have attention deficit hyperactivity disorder.
14 year old girl was brought to adolescent clinic with history of severe low back ache of three years duration. Detailed clinical examination did not reveal any organic pathology. Hematological and radiological investigation were normal. MRI –lumbosacral spine was within normal limits. Bone scan was also normal. There was no relief of pain with pharmacotherapy and physiotherapy. She could not attend her classes regularly due to back ache. On detailed evaluation in the adolescent clinic, she was diagnosed to have persistent somatoform pain disorder. She also had learning disorder and significant academic stress. The backache subsided completely after psychological therapy and there was no further relapse of pain.

7th standard student, presented with history of weakness of both lower limbs of 4 months duration. Detailed neurological evaluation and investigations were normal. On psychological evaluation, he was found to have academic stress, which had caused anxiety and emotional conflict leading to the conversion disorder in the form of lower limb paralysis. After giving psychotherapy, the power of lower limbs improved and he started walking normally within a few hours.
Somatoform Disorders
Physical symptoms that have no organic explanation are quite common in all medical settings. The tendency to communicate emotional distress in the form of physical symptoms is called somatization. Symptoms of patients with somatoform disorder are ‘real experiences’ and are ‘not imaginations’. Somatoform disorders are a broad group of illnesses in which the patients present with bodily symptoms suggestive of a physical disorder for which there are no demonstrable organic findings and for which there is strong evidence that the symptoms are linked to emotional stress or conflicts. The common somatoform disorders seen in adolescents are conversion disorder, pain disorder and somatoform autonomic dysfunction.
Conversion disorder
The patient presents with one or more symptoms affecting voluntary motor or sensory function that suggest a neurological disorder. The common symptoms in conversion disorder includes paralysis, sensory loss, aphonia, tremor, pseudoseizures, dizziness, blindness, deafness etc.
Persistent somatoform pain disorder
The person experiences persistent, severe and distressing pain, for at least 6 months in any part of the body. Those common symptoms are headache , backache, abdominal pain , chest pain and pain over extremities.
Somatoform autonomic dysfunction
The symptoms are presented by the patients as if they are due to a physical disorder of a system under autonomic innervation ie, Cardiovascular (palpitation, chest discomfort); Gastrointestinal (dyspepsia, irritable bowel syndrome, psychogenic vomiting or diarrhea) Respiratory system (psychogenic cough & hyperventilation) & Genitourinary system ( increased frequency of micturition or dysuria)
We should exclude the factors which can negatively influence the learning ability of an adolescent, like family and school related stressors. Evaluation of learning disorder requires individually administered tests of intellectual ability and scholastic skills. Diagnosis is based on the presence of a significant discrepancy between the scholastic skills and the intellectual capacity of the individual. The IQ should be above 70. Other factors which can lead to scholastic backwardness like significant behavioral and emotional problems have to be excluded
Intensive individually tailored one to one remedial training is the treatment of choice for learning disorders. Analysis of errors and development of an individual intervention plan, forms the mainstay of treatment for improving mathematical skills and writing skills.
Associated problems have to be managed adequately for getting optimal results. Behavior therapy is necessary in the management of comorbid Attention Deficit Hyperactivity Disorder. Motivational counseling and social skills training are needed for many teenagers. Parental guidance and family therapy also form important part of the management.
Adolescents with somatoform disorder require psychotherapy & relaxation therapy to manage anxiety related to the stress. Once anxiety is relieved, the physical symptoms will subside. Life skills training should be given to all adolescents to deal effectively with the stressors of life so that stress related disorders can be prevented.
The prognosis of learning disorder depends on the severity of the disorder, the age at which remedial intervention is started and the presence or absence of associated problems. Any student with speech delay, expressive language disorder or scholastic backwardness should be evaluated at the earliest to exclude learning disorders. If we start intensive remedial training at the onset of learning difficulty, learning problems can be remedied. By improving the motivation, self esteem, academic skills and life skills, we can guide the adolescents towards excellence in life.

Posted in My medical specialty | Leave a comment