School Readiness Flashcards
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 Egocentrism Language development Symbolic representation Irreversibility Animism
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 Reversibility Seriation Decentering Ability to do math
Kohlberg’s stages of Moral Dvpt: stage all children are in
Preconventional
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
Growth
Height, weight, maturation
Physical Fitness
Strength, energy, stamina, flexibility
Physiology
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»_space; 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.
Self-confidence
Ability to understand feelings of others
Empathy, acceptance
5Ds #3: Approaches Toward Learning
Inclinations, dispositions, or styles that reflect how children become involved in learning
Predispositions:
Gender
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
5Ds #4: Language Development
Listening
Speaking
Questioning
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
5Ds #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
Artwork
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) M-CHAT-R/F 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
Bullying
Toxic Stress
Mental Health Disorders
Media
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
Insomnia Sadness Stomachaches Headaches Enuresis 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.
Anxiety
Impaired memory and mood control
Mental Health Conditions
(increased stress hormone alters brain architecture»_space; 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
Poverty
Paternal depressive or anxiety symptoms
Childhood stressful life events
Exposure to violence
Adverse effects of screen time
Obesity Inactivity Attention Problems Aggression 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.”
six
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
- Reading together → daily fun family activity;
- Rhyming, playing, talking, singing, and cuddling together → throughout day;
- Routines and regular times for meals, play, and sleeping;
- Rewards for everyday successes → helping, cleaning etc.
- 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
affordability
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
comprehensive
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 Birth-to-Three 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 Diabetes Asthma Sickle cell disease Juvenile idiopathic arthritis Epilepsy 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
