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5.08.2012

My Child is Failing Pre-school!

I recently had a phone call from a concerned mom. Her son's preschool had suggested that she find some type of counseling for her 4-year old who was "acting out."

I conducted my internship at Children's Hospital Outpatient Psychiatry in San Diego, primarily working with kids up to the age of 11. In that facility, we treated a whole host of mental health issues such as bed wetting, school resistance and anxiety, complicated grief after the death of a parent, and navigating challenges related to chronic illness.

So, back to the phone call and this 4-year old boy. Here were my questions for concerned mom:
  • What was the exact language used by the school's staff about child's behavior?
  • How is child's elimination? Potty training, night wetting, holding stool, yeast infections, etc.
  • How is eating? Any odd cravings, likes, dislikes, problems swallowing or digesting certain textures. 
  • How is speech, balance, hearing, and ability to communicate needs?
  • Can child dress himself age-appropriately?
  • How many hours does child sleep? Looking for issues such as night waking, nightmares, too little or not enough sleep, naps?
  • How many hours does child attend preschool? Most kids this age prefer to be in their own home. This little man was now in school from 8:30-2:30 four days a week. That's full-time!
  • Anything going on in the home, new or different? 
  • What is the model of learning in the preschool? Each preschool has a specific model and they vary dramatically.
  • How does child respond to limits and consequences?
  • Does child smile, seem to feel joy, and appear attached to caregivers?
  • Any physical sensitivity to clothing, tags, textures, or sounds?
  • How is child's overall physical well-being? (Coordination, range of motion, etc)
  • Any unusual tics, repetitive motions, habits, bodily gestures? i.e. coughing, throat clearing, counting, stepping patterns, hair or skin pulling.


After I spoke with mom for about 20 minutes, I had gathered tons of helpful info. The boy's teacher had reported that the child was "spitting, throwing, and kicking." Also, he didn't like other children to join in his activities. 

I also learned that her son had fully potty trained very early (even dry at night!). He was social, kind, sweet, and loving. New changes, by gosh, yes, a new baby sister in the last three months, which is exactly when he was sent off to preschool for the first time. Maybe this is a simple case of bad timing? Big brother is packed off to school just as new sweet baby girl is brought home.

A teacher recommendation to a parent for outside professional help, expressed concern for a youngster's behavior, always holds some water for me. Parents can be blind to a child's problematic behavior and teachers and administration see a nice range of typical behavior. The tall blade of grass, the kid that is not gelling well, is something to acknowledge, to some extent.

When assessing a child's behavior, the whole person is viewed. In other words, if we were looking for early signs of a serious condition, say, something on the Autism Spectrum, we would see multiple levels of dysfunction...eating habits, sensory reactivity, emotional mood swings, concerning body movements. So, if all areas seem developmentally appropriate, except one carved out piece, we can then relax a little bit and see a child's behavior as "temperament." What in the child's environment can better accommodate his temperament.


This little boy sounded very bright to me...and once I was told of his preschool learning model, I suggested that either he may not be ready for preschool, or, maybe this particular school is not a good fit. 

*Too much structure or not enough structure in the learning environment?

*Too many kids, too little teacher time?
*Too much time AT preschool?

All of these things determine what is a GOOD FIT for your child.

A great preschool for my child may not be a great preschool for your child.

No need to pathologize (making something a mental health issue) what simply isn't working for a child. Sometimes, things just don't work. In the end, I did not set up an appointment for this family. I suggested a terrific book that will help the family read their son's low-level cues and they will re-evaluate their child's preschool needs.