WHEN WE run a fever, we suspect that something is wrong with our bodies--a virus perhaps or a bacterial infection. The elevated temperature is a symptom of a deeper problem, though left untreated it can become a cause for additional problems. Such is the case with scores on standardized tests. If test scores start to drop, that may be an indication of deeper problems. Left unaddressed, declining test scores can become the cause of other problems, both for individual students and for entire schools. Researchers know a great deal about how to improve schools, but they have spent less time trying to understand what causes schools to decline in the first place. (1) One probable reason for the scarcity of research is the reluctance of declining schools to place themselves under the microscope. Here I argue that knowing the possible causes of school decline, especially an initial drop in performance, is critical for educators who want to intervene early. Failing to nip student achievement problems in the bud can set into motion a dangerous downward spiral in which every downturn triggers new problems and accelerates the school's rate of decline. (2) Of course, some low-performing schools do not experience decline, because they have never performed well. My focus here is on schools that once were characterized by adequate or even good performance but have begun to slip. A number of these schools have participated over the past four years in the University of Virginia's School Turnaround Specialist Program (STSP). This unique outreach program combines the talents of experienced educators and faculty members from the Curry School of Education and the Darden Graduate School of Business Administration. The goal is to train principals to be school turnaround specialists and to support them in their efforts to reverse a downward trend in school performance. As research director for the STSP, I have spent the past four years working with a team of researchers to understand the circumstances that confront these school turnaround specialists and to discover how they deal with them. This knowledge, combined with what we know from previous investigations of school decline, has led us to identify a number of potential indicators of school decline. By attending to these indicators when they first surface, educators are more likely to prevent a school from slipping into a self-perpetuating downward spiral. The approach I take here may best be characterized as a challenge-and-response analysis. Schools face challenges from time to time. Among the challenges associated with school decline, I want to focus on four that are common: serious budget cuts, new state and federal mandates, the loss of key personnel, and an influx of at-risk students. (3) Strictly speaking, these challenges do not cause schools to decline, but decline is a consequence of failing to address these challenges effectively. In medicine, specialists in iatrogenic medicine study medical problems created or exacerbated by improper medical practice. Education needs an equivalent enterprise devoted to examining the academic problems created or exacerbated by inadequate educational practice. Problems in addressing challenges can be found at the levels of the individual, the group, and the school. Individual teachers may fail to recognize when particular students need help, or they may prescribe a treatment that actually makes matters worse. Groups of educators may invest more energy in diverting blame for low performance than in correcting problems, thereby delaying much-needed reforms. School leaders may fail to recognize systemic issues that undermine a school's ability to raise achievement. In some cases, these failures are ones of omission. Nothing is done to address a challenge. In other cases, the problem is a failure of commission. Actions are taken, but they are inadequate or inappropriate. Here I want to identify 11 early indicators of school decline that are associated with inadequate and inappropriate responses to the aforementioned quartet of challenges. …