School Readiness Flashcards Preview

SPRING16 N833 Adv Pedi > School Readiness > Flashcards

Flashcards in School Readiness Deck (95):

Erikson’s Stages of Psychosocial Development: Preschool (3-5yo)

Initiative vs Guilt


Characteristics of Erikson's "initiative vs guilt" stage

(preschool - 3-5yo)

Children begin to assert themselves, plan activities, make up games, and initiate activities

Resolution: Purpose


Erikson’s Stages of Psychosocial Development: School age (6-11yo)

Industry vs inferiority


Characteristics of Erikson's "industry vs inferiority" stage

(School age - 6-11yo)
Children need to cope with new social and academic demands

Resolution: Competence


Piaget's Stages of Cognitive Development: 2-7 yo

Preoperational Stage


Characteristics of Piaget's Preoperational Stage

(2-7 yo)
Key feature: Centration
Language development
Symbolic representation


Piaget's Stages of Cognitive Development: 7-11 yo

Concrete operational


Characteristics of Piaget's Concrete operational stage

Key feature: Conservation
Thinking logically about concrete events
Ability to do math


Kohlberg's stages of Moral Dvpt: stage all children are in



Characteristics of Kohlberg's pre-conventional stage (stage 1)

Authority is outside of the individual and reasoning is based on the physical consequences of actions
Stage 1: Obedience/Punishment
Child is good in order to avoid being punished
If punished, they must have done something wrong


Characteristics of Kohlberg's pre-conventional stage (stage 2)

Authority is outside of the individual and reasoning is based on the physical consequences of actions

Stage 2: Self-interest driven
What’s in it for me?
Child is good in order to obtain rewards
Begin to recognize that there is not just one right view


Social and emotional dvptl milestones at 3 years

Copies adults and friends
Shows affection for friends without prompting
Shows a wide range of emotion
Understands concept of “mine” and “his” or “hers”


Language/communication dvptl milestones at 3 years

Follows instructions with 2 or 3 steps
Talks well enough for strangers to understand most of the time
Carries conversation using 2 to 3 sentences


Cognitive dvptl milestones at 3 years

Plays make-believe with dolls, animals, and people
Copies a circle
Builds towers of more than 6 blocks
Does puzzle with 3 or 4 pieces


Movement/Physical Development
milestones at 3 years

Climbs well
Runs easily
Walks up and down stairs, one foot on each step


Social and emotional dvptl milestones at 4 years

Is more and more creative with make-believe play
Would rather play with other children than by himself
Talks about what she likes and what she is interested in


Language/communication dvptl milestones at 4 years

Tells stories
Knows some basic rules of grammar
Can say first and last name
Sings a song or poem from memory


Cognitive dvptl milestones at 4 years

Names some colors and numbers
Draws a person with 2-4 body parts
Starts to understand time
Tells you what he thinks is going to


Movement/Physical Development
milestones at 4 years

Hops and stands on one foot for up to 2 seconds
Catches a bounced ball most of the time
Pours, cuts with supervision, and mashes own food


Social and emotional dvptl milestones at 5 years

Wants to please and be like friends
More likely to agree with rules
Is aware of gender
Can tell what is real and what is make-believe


Language/communication dvptl milestones at 5 years

Speaks very clearly
Tells a simple story using full sentences
Uses future tense
Says name and address


Cognitive dvptl milestones at 5 years

Counts 10 or more things
Can draw a person with at least 6 body parts
Can print some letters or numbers
Knows about things used every day like money or food


Movement/Physical Development
milestones at 5 years

Hops; may be able to skip
Uses a fork and spoon, sometimes a table knife
Can use toilet on their own
Swings and climbs


In 1991, the National Education Goals Panel adopted as its first goal that ...

“by the year 2000, all children will enter school ready to learn”


Components of School Readiness

Readiness of the child
School’s readiness for children
Family and community supports contributing to child readiness

(multidimensional, interdependent)


Common Misconceptions about school readiness

Learning happens only at school
Readiness can be measured easily
Readiness is mostly a function of time (maturation) and some children need a little more
Children are ready to learn when they can sit quietly at a desk and listen
Children who are not “ready” do not belong in school


Five Dimensions of Readiness

Physical Well-Being and Motor Development

Social and Emotional Development

Approaches Toward Learning

Language Development

Cognition and General Knowledge


5 Ds
#1: Physical Well-Being & Motor Development: Physical

Height, weight, maturation

Physical Fitness
Strength, energy, stamina, flexibility

Optimal functioning of body systems


5 Ds
#1: Physical Well-Being & Motor Development: Motor

Gross Motor Skills
Walk, run, jump, climb

Fine Motor Skills
Use scissors, fasten buttons

Sensorimotor Skills
Hear, see, touch, kick rolling ball

Oral Motor Skills
Sucking, producing sound, coordinating breathing


Significance of motor delays when assessing school readiness?

Motor delays may be first or most obvious sign of global developmental disorder

Early identification >> Early interventions


AAP recommendations regarding motor delay screenings

Standardized developmental screening (including motor development) at 9, 18, and 30 months
Additional screening test at 4 years before child enters Kindergarten


Motor expectations at 9mo visit

infant rolling to both sides, sitting without support, showing motor symmetry without established handedness, grasping and transferring objects from hand to hand


Motor expectations at 18mo visit

toddler should sit, stand, walk independently; grasp and manipulate small objects; mild motor delays undetected at 9 months may be apparent at 18 months


Motor expectations at 30mo visit

most motor delays will have already been identified at previous visits; more subtle gross motor, fine motor, speech, and oral motor delays may emerge at 30 months; progressive neuromuscular disorders may emerge as loss of previously attained motor skills


Motor expectations at 48mo visit

preschooler should have early elementary school skills; emerging fine motor, handwriting, gross motor, communication, and feeding abilities that promote engagement with peers in group activities


5 Ds
#2: Social and Emotional Development: Social

Ability to form and maintain social relationships with adults and peers

Communicate with adults and understand adult roles

Cooperate with peers

“Treat others as you would like to be treated”

Listen to others

Provide help and support for friends


5 Ds
#2: Social and Emotional Development: Emotional

Ability to separate from parents

Self-regulation of emotions
Joy, fear, anger, grief, disgust, delight, horror, shame, pride, guilt, etc.


Ability to understand feelings of others
Empathy, acceptance


#3: Approaches Toward Learning

Inclinations, dispositions, or styles that reflect how children become involved in learning

Temperament (easy, slow to warm up, difficult)
Cultural Patterns and Values

Learning Styles:
Openness to and curiosity about new tasks and challenges
Initiative, task persistence, and attentiveness
Reflection and interpretation
Imagination and invention
Cognitive styles


#4: Language Development

Social Uses of Language:Express emotions, get/give information, manners
Vocabulary: Understand words and sentences, Create complex sentences
Creative Language: Rhyming, storytelling
Literature Awareness: Interest in books/magazines, recall familiar stories
Print Awareness: Assigning verbal sounds to letters, recognize own name in writing
Aware of Story Sequence: Beginning, Middle, End
Writing: Ordered scribbling


#5: Cognition and General Knowledge

Physical Knowledge
Learning about objects by observation and experience
E.g. A red, heavy ball rolling downhill

Logic-Mathematical Knowledge
Similarities, differences, and associations between objects, events, or people
E.g. A red and blue crayon are different based on color, but are the same based on size

Conventional Knowledge
ABCs, colors, numbers, etc.

Ability to use problem-solving and imagination


Ways to evaluate Development & School Readiness (generally)

Developmental Surveillance

Screening Tools

Neurologic Exam



Developmental Surveillance: AAP recommends...

Developmental surveillance at ALL well-child visits


5 Components of developmental surveillance

Eliciting and Attending to the Parents’ Concerns

Maintaining a Developmental History

Making Accurate and Informed Observations of the Child

Identifying the Presence of Risk and Protective Factors

Documenting the Process and Findings


Developmental Screening Tools

Ages & Stages Questionnaire
Denver II
Parents' Evaluation of Developmental Status (PEDS)
Pediatric Symptom Checklist


ASQ: what and who?

Ages 1 month to 5 ½ years
Parent-completed questionnaire
Screens communication, gross motor, fine motor, problem-solving, and personal adaptive skills


Denver 2: what and who?

Ages 1 month to 6 years
Directly administered to child
Screens expressive & receptive language, gross motor, fine motor, and personal-social skills


PEDS: What and who?

Birth to 8 years
Parent interview form
Screens for developmental & behavioral problems needing further evaluation


M-CHAT-R/F: what and who?

Ages 18 months and 24 months (AAP Recommendation)
Parent-completed questionnaire
Identifies children at risk for Autism Spectrum Disorder


PSC: what and who?

Ages 4 to 18 years
Parent-completed version and youth self-report (ages 11+)
Psychosocial screen to recognize cognitive, emotional, and behavioral problems


Components of neuro exam

While taking history, observe child
Cranial Nerve Exam
Fundoscopic Exam: Detectable and symmetric red reflexes?
Facial Expressions: Quality of smile, cry
Oromotor Movement: Palate, tongue, Observe using straw or blowing kisses
Sensation: Test touch & pain sensation
Strength Assessment: Posture, grasp
Gait Assessment: Unsteady?
Deep Tendon Reflexes: Diminished? Absent? Increased?
Gross Motor Skills: Hop, run, skip, throw, stair climb, 1-foot stand
Fine Motor Skills: Button, zip, snap, tie, draw


Dyspraxia =

inability to formulate, plan, and execute complex movements (test with gross and fine motor skills)


Why use Draw-a-person test?

Originally developed to predict intelligence, now shows cognitive, motor, creative, visual, spatial, etc


Stages of draw a person test

Scribble stage (2-4y)
Pre-schematic stage (3-7y)
Schematic Stage (6-11y)


Scribble stage of draw a person test

(2-4 years):
Random marks, dots, and lines
Kinesthetic and imaginative


Pre-Schematic stage of draw a person test

(3-7 years):
Representative symbols for objects in environment
Circles, squares, and lines
Pictures are “floating”


Schematic stage of draw a person test

(6-11 years):
Repetition of symbols for familiar objects
Ex. Lollipop tree, scarecrow-type people, row of identical houses)
Use of the “base-line”


Standardized testing and school readiness?

Standardized testing may not be accurate or reliable indicator of school readiness
concerns re: labeling


Current Connecticut Enrollment Requirements: Kindergarten

All children who turn 5 before January 1st of the current school year may enroll in kindergarten
Child must be enrolled in school by 7 years old
Children must have physical within last year
Up to date immunization records
CT Department of Early Child Education petitioning for change in date to October 1st of current school year


Why would parents chose to delay kindergarten enrollment?

Age of child close to enrollment cut off

Development of child:
Delay in motor and gross development
Delay in social or emotional development
Delay in cognitive development
Delay in language development

Preference of parent :
Want child to enter old, taller, with higher cognitive and emotional skills


What is Academic Redshirting?

4-5.5% of children delay kindergarten
Tend to be Male, White, High SES
Birthday close to cut off date
Low birth weight


Performance differences in delayed enrollment?

Studies show that initially older children perform better, but that differences disappear by the 3rd grade


What is academic greenshirting?

Early enrollment
Tends to be black, asian, low SES


Why enroll early?

Cost of an additional year of preschool


Child based RFs associated w/decreased school readiness

Physical Disabilities
Learning Disabilities
Intellectual Disabilities
Emotional and social maladjustments
Adverse Childhood Events


Family based RFs associated w/decreased school readiness

Low maternal education
Single parent households
Low parental literacy
Household with few or no books
English second language


School based RFs associated w/decreased school readiness

Schools that fail to recognize or accommodate special health problems, developmental needs, and cultural differences of incoming students


Protective Factors for School Readiness

High maternal education level
Living with both parents
High parental involvement in education
Supportive student teacher relationships


Red Flags For School Problems

Toxic Stress
Mental Health Disorders


Effects of bullying:

Lower achievement, feeling unsafe, feeling as if one does not belong at school, and feeling sad were all positively associated with being a victim


Signs of Bullying

Difficulty Concentrating
Symptoms of Anxiety or depression
High rates of school absence


What is toxic stress? What causes it?

When a child experiences strong, frequent, and/or prolonged adversity without adequate adult support.
Physical or emotional abuse
Chronic neglect
Caregiver substance abuse or mental illness
Exposure to violence
Accumulated burdens of family economic hardship


Consequences of toxic stress

Impaired educational achievement, economic productivity, health status, and longevity.
Impaired memory and mood control
Mental Health Conditions

(increased stress hormone alters brain architecture >> linguistic & cognitive probs)


Primary prevention of toxic stress

Routine anticipatory guidance that strengthen a family’s social supports
Encourage a parent’s adoption of positive parenting techniques
Facilitate a child’s emerging social, emotional, and language skills: Promotion of the 7Cs of resilience (competence, confidence, connectedness, character, contribution, coping, and control); Reach Out and Read


Secondary prevention of toxic stress

Screening for developmental delays at 9, 18, and 24/36 months

Screening for risk factors for toxic stress:
Maternal depression
Parental substance abuse
Domestic or community violence
Food scarcity
Poor social connectedness


In children transitioning to formal schooling, approximately___ in ____ (__%) will have a psychiatric disorder with impairment and may benefit from services

one in five (21.6%)


Risk Factors for psych DOs with impairment

Paternal depressive or anxiety symptoms
Childhood stressful life events
Exposure to violence


Adverse effects of screen time

Attention Problems
Sleep Problems


In a study of children 15-48 mos, “Children who started watching television at 2 h/day were approximately ___ times more likely to have language delays.”



AAP Recommendations on Media

No screen time for children less than 2
No more than 2 hours of screen time per day after two
TV off during mealtimes
No TVs in child’s room
Substitute TV time with reading, games, hands on time together


Dimensions of Readiness
of the school itself

Goals of Early Education

School Systems

Classroom and teaching environment

APRN involvement


#1: Goals of early education
The “5 Rs” in the first 1000 days of life

1. Reading together → daily fun family activity;

2. Rhyming, playing, talking, singing, and cuddling together → throughout day;

3. Routines and regular times for meals, play, and sleeping;

4. Rewards for everyday successes → helping, cleaning etc.

5. Relationships that are reciprocal, nurturing, purposeful, and enduring,


Readiness of school
#2: School Systems

NEGP (2010) outlined some characteristics of schools that support learning and development:

Sensitive to the needs of the child – “individualized learning”

Welcoming of parental involvement

Sensitive to cultural diversity and differences, including poverty, race, and disability

Help kids make the transition between home/childcare and school


Readiness of school
#3: Strong Classrooms

Teachers have knowledge of early child development

Small-group, child-led/ teacher-supported learning.

Lessons should be meaningful to the child

Hands-on activities


What to look for in quality childcare/preschool

Small staff-to-child ratios and low staff turnover

Developmentally appropriate curriculum

Help ease the transition to kindergarten



What is head start?

Enrollment based on federal poverty guidelines

Head Start mandates COMPREHENSIVE SERVICES to children and families - a unique feature of the program


Services provided by head start


Health Services – physical health, oral health, mental health, nutrition and physical activity; prenatal care

Education Services, including Disabilities/Special education

Family Services thru Family Partnership Agreement, parent engagement and governance, fatherhood initiative, etc.

Community Partnerships


APRN role in readiness of school

Consider school setting as a factor when children are frequently ill, fearful, anxious, and “inattentive or impulsive”

Know schools in the area (type of school, environment)
Ask parents about their experience with school
Maintain connections with school nurses, APRNs and school counselors

Refer to school for IEP and 504 plans

APRNs are welcomed in school settings (ex. PPT meetings) as advocates of the child

Ask questions and inquire about school at every WCC – Be proactive!


Barriers to aprn role in readiness of school

Time consuming and requires intensive follow-up and coordination

Requires connections, contacts and relationships with school system

How to bill and get paid for these services?
Telephone codes, care plan coordination codes, case management codes
Reimbursement is unreliable, dependent on insurance and documentation


Dimensions of support systems for school readiness

Family Characteristics
Community Systems
Special Populations
Children with Special Education Needs


#1 family characteristics

How can I help my child grow and develop and be a part of the family?

Parents as a child’s first teacher

Parental involvement in child’s development is crucial

Reading together
Rhyming games
Memory games
Cooking together

Sleep hygiene and routines


#2: Community Systems

Prenatal care
Clean and healthy environment
Access to high quality preschools
Youth programs
Local libraries


#3: Special Populations
LGBT parents
Undocumented/refugee families
Cultural and language barriers (ESL, immigrants)
Single parent households
Father involvement
Talented and gifted students
And many more…

How do you assimilate all these diverse populations, backgrounds, experiences and biases into a standard public educational/healthcare framework?

You can’t. But the APRN should try and provide as much support as possible

Refer to community groups, forums where like-minded parents can share experiences.
Connect families to government-funded resources
TAG students – local groups, f/u with school for evaluation
ESL classes for immigrants


#4: Children with Special Education Needs

Who needs additional support in the classroom?

Motor delays
Sensory delays
Intellectual delays
Chronic medical condition
Sickle cell disease
Juvenile idiopathic arthritis
And many more…


What is IDEA? APRN Role

Individuals with Disabilities Education Act (IDEA) – “Special Ed”
IFSP (Individual Family Service Plan): for children birth to 3 years
IEP (Individual Education Plan): 3-21 years
Assessment by multidisciplinary team
IEP might include: tutoring, PT, OT, speech therapy


What are 504 plans? APRN role

504 Plan: Section 504 of the Rehabilitation Act

Accommodations in regular classroom (eg: for ADHD, T1DM, allergies, etc)

APRNs can and should write letters to school for IEP and 504 plan referrals