School Readiness 08.20.2012

7/31/2019 School Readiness 08.20.2012

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School ReadinessMichelle Vo, M.D. PGY-5

Triple Board Morning Report

August 20, 2012


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One day in continuity clinic

J.J. is a 5 year old male who comes in with his mother and

father at the end of July for a well-child visit. He just turned five

this month. His mom wants to know if he should start

kindergarten this year as they originally planned, or if theyshould delay kindergarten entry so he will have a year to

become more mature.

J.J.s dad wants to know if they should delay kindergarten so that

J.J. can have an advantage when playing sports when he is

older.


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I have excellent timing.Salt Lake Tribune, August 19, 2012 (hot off the press!)


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Back to your office. You learn

moreJ.J. currently attends half-day preschool 3 days a week.

He was last seen in the clinic 2 years ago, when you noted that

he is a very active child who was fairly slow to warm up.

Mom says, He likes to have things a certain way. He needs

routines. She is worried that J.J. wont keep his shoes on at

school because he needs to have the seam in his socks exactly

right. He will also go to private school for kindergarten and

shes worried he may refuse to wear the uniform because hedoesnt like buttons.


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Now you are interested. So you ask

about:Separations: J.J.s mom was the one who had a hard time

separating from J.J. when he started preschool a year ago. She

cried. He was reportedly fine.

Mood: Most of the time hes really a happy kid

Sleep: J.J. has an elaborate bedtime routine that takes about an

hour to complete. He has many requests before he finally lays

down, and his mom lays down with him until he falls asleep. He

sleeps from 9:00pm until 7:00am. He comes to his parentsbedroom about twice a month.

Appetite: He has to eat the same thing for lunch each day: a

turkey sandwich with cheese, no crusts. He always eats the

bread first, then meat, then cheese. He is a very picky eater.


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Other pertinents

Past Medical History: Full term, uncomplicated pregnancy anddelivery. No chronic medical illnesses. No surgical history.Immunizations UTD. Had a rash with amoxicillin this year afterhe was treated for strep throat.

Developmental History: no language delay. Met all milestones ontime.

Family History: Mom has anxiety treated with Zoloft and Xanax.She was diagnosed in her 20s after she had anxiety that kept

her in bed for weeks. Extended family members havedepression and anxiety disorders, including OCD. No familyhistory of bipolar disorder, suicide attempt or suicidecompletion, or psychosis/schizophrenia.


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Should J.J.s family delay

kindergarten? There is almost never an awesome reason to keep a child out

of school

Kindergarten provides socialization, learning, and school

readiness activities, which is often what an immature childneeds

Assessment and intervention through the school system: the

earlier, the better!

Preliminary data suggest that old-for-grade students have

increased rates of behavioral problems (particularly as

adolescents)

Specifically in Utah, there are age limits for student athletes (no

19 year olds)


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And, what does immature mean,

anyway? When parents are concerned and are considering holding their

child back, use this as a springboard concern!

What concerns them about their child?

The immature childs parents may have identified something

that may need evaluation, intervention, or school

accommodations

Rule out developmental delay, identify the child at risk forattention or learning problems

Balance appropriate concern with a healthy respect for

individual variation- there is a substantial variation at this age!


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Developmental Tasks Facing

Children at School Entry Separation

Increasing individualization

Integration of cognitive skills

Ability to form relationships with other children and adults

Ability to participate in group activities and follow rules and

directions

Gradual formation of a sense of self or identity, both inside and

outside the family environment


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Social-Emotional Skills at School

Entry

Self-regulation

Executive function: planning, organizing, following directions

CapacCapacity to be responsive to teachers

Ability to master new experiences

Play skills (taking turns, sharing)

ity to tolerate separations from caregivers


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Identifying the Child at Risk for

Learning Disabilities

Use your Reach Out and Read

book to assess early reading skills

The most common learning disabilityis dyslexia, or a specific problem inreading

Targeted questions and

developmental tasks that assess earlyreading skills:

Letter identification

Letter-sound association

Verbal memory (recalling asentence or story that was just told)

Rapid naming (rapidly naming acontinuous series of familiarobjects)

Expressive vocabulary or wordretrieval (naming single picturedobjects)

Conservative estimates of the

prevalence of learning

disabilities is 7% of school agechildren


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Assessing Attention and Learning

Digit span: a five year old

should be able to recall 4

numbers

Serial commands: a five yearold should be able to perform at

least 4 directions

How does the child behave in

your office? How does s/he

respond to your exam? Created by a 5 year old while I

interviewed his mom. Does this

child have ADHD?


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Copying figures: a review

Circle: 3 years

Cross: 4 years

Square: 5 years

Triangle: 6 years

Diamond: 7 years

Present the figures for the child

to copy (dont demonstrate how

to draw them!)

Tripod grasp of the pencil orcrayon should be seen at age 5


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Drawing Interview

Ask the child to draw a person while the clinician interviews the

parents (Please draw a picture of a boy or a girl.)

The drawing interview consists of questions you ask the child

to engage him/her in conversation:

Do you think it is a picture of a boy or a girl?

Tell me a make-believe story about this boy or girl.

If no response, restate the above: tell me something about this boy

or girl

What else is s/he doing?

When the child stops, repeat what was said. Add, what else

happens to the boy/girl?

This is fun, but dont over interpret the drawing. This is not an inkblot test.


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So, does J.J. have Obsessive-

Compulsive Disorder, or what?

J.J.s mother feels that his preferences do not particularly interfere

with the familys functioning.

His dad finds his bedtime routine somewhat laborious, but the family is

not particularly interested in changing J.J.s behavior at this point.

J.J.s preschool teachers have not identified any behavior problems,

and it appears that he is functioning well in preschool.

J.J. is able to meet expected developmental norms during your

assessment.

What is your anticipatory guidance?


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References

Dixon and Stein, Encounters with Children. Fourth ed. Mosby-Elsevier, 2006.

Dworkin, PH. School readiness. Curr Opin Pediatrics. 3:786,

1991.

Sturner, R, and B Howard. Preschool development I:

Communicative and motor aspects. Pediatrics in Review.

18:291, 1997.

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School Readiness 08.20.2012