The assessment of the child at school entry.

Most learning and behavior disorders in school children present as crisis situations, when anxious parents or exasperated teachers suddenly call for medical or psychological help with a child aged 9, 10, or 11 who is in severe difficulties. It is not surprising that remedial efforts to help these children are often unsuccessful. It seems likely that if we could identify the children earlier and try to help them before they get into difficulties, the results would be much better. However, the correlation between abnormalities found in babies in the newborn period or in the early years of life, although significant, are quite low, and we cannot identify with any degree of reliability children who may have school difficulties at this earlier age. On the other hand, we have shown that a thorough assessment of the child at school entry will allow one to identify quite a large proportion of the children who are going to get into difficulties.1 A careful assessment, therefore, of children at school entry is an essential part of educational pediatrics. There are a number of other reasons why preschool assessments cannot identify potential problems. The main one is that there are a number of functions emerging about age 5 or 6 which cannot be adequately studied in the early years. A further, and very important, reason for putting a great deal of emphasis on the initial examination at school is that whatever administrative arrangements, under the various systems of medicine that operate in different countries, are made in the preschool period to see children, it is difficult to be certain of seeing all the children. It is just those children who are not brought by their parents for regular preschool examinations who are most likely to be among those who run into difficulties.