SCHOOL DIFFICULTIES detailed history review of school records detailed physical exam environmental. neglect physical abuse and domestic violence sexual abuse sleep issues nutrition and feeding issues malnutrition socio-economic cultural home environment issues bullying mental health anxiety depression behavioral disorders conduct oppositional defiance disorder substance use and abuse neurodevelopmental intellectual disability global delay specific learning disability attention-deficit hyperactivity disorder autism spectrum disorder medical hearing impairment visual changes neurological disease tumor seizures head injury neurodegenerative disease sleep issues obstructive sleep apnea hypothyroidism iron deficiency

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