When your child has problems in preschool

Preschool is often the first organized setting many kids have been in, so it can also be the first time that learning or developmental problems might surface.

Four-year-old Nathan Bowen of Laurel was eager to start preschool last year. He loved learning and playing with other kids so it was a surprise when he started having difficulties.

As a baby and toddler, Nathan hit every milestone on time or even early and was "very bright," says his mother, Amanda Bowen. "We saw no cause for concern," she says.

That is until his preschool teachers began sharing their concerns about Nathan's behavior. He was easily frustrated, anxious about transition, had trouble sharing and manipulating toys and was unable to sit still. The structure of preschool was a struggle for Nathan, Bowen says.

"He needed constant redirection," she explains. "It was definitely hard to hear and very emotional, but I was determined to learn all I could and get him the very best treatment."

There are many stories similar to Nathan's — children who showed no signs of delays or difficulties until they started school.

preschoolprobs1WPreschool is like a Petri dish, says Carrie Grimes, director of the Preschool for the Arts at St. Anne's in Annapolis. It's a place where behavior, development and changes can be observed daily. And often it's a time when developmental and learning delays surface for the first time.

Whether a child is having trouble sitting still for story time, becoming aggressive with other kids, or not recognizing letters and numbers, preschool teachers say they are on the lookout for red flags for developmental or learning delays.

"This is the first time that many families are getting feedback about their children," Grimes says. "If there is some sort of issue or syndrome or problem, the earlier you can intervene and provide support, the better for the child to get them what they need. The sooner you can provide for that child, the better the outcome."

Although preschool teachers will not make a diagnosis, most will communicate concerns with parents.

Nathan was eventually diagnosed with sensory processing disorder and a fine motor delay, which resulted in an individualized education plan and occupational therapy.

"Nathan has greatly benefited from the understanding and the extra support he is receiving from everyone involved," Bowen says.

Noticing, acknowledging and talking about red flags for learning and development is essential in preschool, says Joan Mele-McCarthy, executive director of the Summit School in Selby-on-the-Bay.

See below for some common problems that can surface in preschool. Keep in mind, however, that these red flags may be indicators of a serious issue, a family issue or they might just be a normal part of preschool development, says Cindy Sandler, a Columbia-based psychologist who works with children with learning and attention issues.

Attention Issues

RED FLAGS: Inability to sit still, disruptive, acting out, acting sillypreschoolprobs2W

Squirming during story time is to be expected in preschool. It's not easy for 3-, 4-, and 5-year-olds to sit still for long periods of time, but they should be able to sit and listen to a story or play one activity for 20 minutes, Grimes says.

Preschools often try to create an activity-based program where students aren't expected to sit still for long stretches, Mele-McCarthy says. So if children still have difficulty paying attention at activity centers or focusing on one activity, early intervention might be necessary.

"When they seem to still be driven by a motor by age 4, they might need some help," Mele-McCarthy says.

Attention issues include both children who seek attention by acting out in class, pushing buttons or becoming physical with peers, and children who lack attention and are unable to sit still, follow directions or focus on an activity for very long.

"Attention-seeking or attention-lacking behaviors are ones that we really keep our eyes on," Grimes says.

Avoidance Behaviors

RED FLAGS: Resisting going to school, refusing to engage, transition problems

Many children have trouble adjusting to preschool. Crying or clinging to parents the first week or so is to be expected. But there might be a problem if children consistently resist going into the classroom, refuse to engage in group activities or have trouble participating, Grimes says.

These children might also have trouble transitioning between activities, she says. Whether they stall or refuse to start an activity or they act out or throw a tantrum, there might be deeper issues involved.

"We try to ease the transition and encourage children to talk about their feelings related to the activity," Grimes says. "It might be indicative of a more lasting problem."

By age 3 or 4, children should be able to interact appropriately, play actively with peers (instead of parallel play) and manage frustrations effectively most of the time, Sandler says.

"What's most important in preschools is that children learn to play and interact with others and handle their emotions," she says.

Difficulties with Fine and Gross Motor Development

RED FLAGS: Clumsy, awkward gait; problems coloring and drawing

Preschoolers aren't always the most graceful creatures, but an awkward gait or inability to use utensils or color or write effectively could mean delays in fine and gross motor development, Mele-McCarthy says.

Frequent falls could be a sign of a gross motor delay, and the inability to draw a circle by age 3 could be a sign of a fine motor delay. These children could benefit from extra attention, occupational therapy or other treatment geared to these skills, Mele-McCarthy says.

Speech and Language Delays

RED FLAGS: Not talking or difficult to understand, minimal interaction with peers, lack of eye contact

By age 3, children are mini-conversationalists, Mele-McCarthy says. Although they most likely won't pronounce every word or letter correctly, 3-year-olds are eager to share their thoughts and interact with adults and other children.

"At that magic age of 3 years, when kids have little abilities to converse, you should be able to understand them pretty well," she says.

An evaluation might be necessary for children who are talking a lot but aren't intelligible, or for children who are mostly quiet and do not interact much with peers or adults.

Other signs of a speech or language delay could be a lack of eye contact, an inability to understand rhyme or not being aware of letter sounds. These children might not enjoy listening to stories, and they might remember the "Alphabet Song" one day, but not the next, Sandler says.

Children with speech and language delays often experience other difficulties in preschool, such as behavior problems or an unwillingness or disinterest in participating in school activities.

Unusual Sensory Behaviors

RED FLAGS: Putting things in the mouth, uttering unusual sounds

Babies and toddlers are known for constantly putting everything in their mouth, which is a way of seeking oral stimulation. Once children are preschool-aged, however, these types of behaviors should subside. Preschoolers who constantly bite, chew or suck on things like their shirtsleeves or toys in the classroom might need extra sensory stimulation, Grimes says. Making unusual sounds at inappropriate times is also an indicator of a sensory issue.

For children who need sensory stimulation, there are often activities or manipulatives that can help, says Meg McClary, director of Little Creek Preschool in Chestertown. Children who experience sensory overload might need some downtime away from the commotion.

Some children are either overly sensitive or under sensitive, Sandler says.
"Both can generate the same reactions or behaviors for very different reasons," she says.

Children who are under sensitive might be overly physical and can't moderate their actions. Children who are overly sensitive might not be able to handle certain sights, sounds, textures or foods. Sensory-seeking behaviors can be disruptive — biting, constantly rocking or tapping or clicking items to make noise in the classroom.

While each of these red flags doesn't necessarily mean there is a problem, two or more can be indicators of conditions such as ADHD, autism, dyslexia or sensory processing disorders, Sandler says.

"Every child develops skills at a certain pace," she says. "It's looking at a cluster of difficulties. Intervention is extremely important."

For Nathan Bowen, the extra help has been invaluable.

"Early intervention is vital," Bowen says. "When children are young, some behaviors may seem somewhat cute, but if these issues are not addressed, it can become much more serious and harder to handle. Every child deserves their best chance ... Nathan is thriving, and I am so grateful."

Don't miss our preschool directory.

Also see our story on Preparing for the preschool transition