Open letter to parents with children in the second cycle of preschool education

The second cycle of early childhood education, although not a determining factor, is the ideal time to prevent school failure.

Dear Parents:

This post is aimed at those parents who have children starting the second cycle of preschool, 3-5 years old, and have noticed that your children are beginning to show some learning problems in the basic content of this cycle.

Here I will only discuss situations where individuals have not already been diagnosed with ASD, intellectual disability, or any other serious neurodevelopmental disorder that, in itself, we know will inevitably lead to academic difficulties. I will only refer to those that the WHO classifies as Psychological Development Disorders (F80-F83). 

Before we go any further, what should parents know?

1. There is significant variability in individual development, and it is precisely at these ages that this variability is most evident. Therefore, they are alert, though not particularly worried.
2. That for some of the problems mentioned, especially regarding reading and writing, we cannot make a definitive diagnosis before the age of seven.

SPEECH AND LANGUAGE DEVELOPMENT DISORDERS

1. TE of the pronunciation

Simply put, this problem refers to situations where our children don't pronounce words correctly (speech sound disorders). This is not usually something to worry about. It typically resolves itself gradually and tends to disappear around 4-5 years of age. If it persists, speech therapy intervention may be necessary, with the goal of it disappearing completely by elementary school (6 years old), if possible.

This TE includes lambdacism (substitution of r for l) and phonological alterations (defect in the correct pronunciation of sounds).

2. TE of language expression

Language production is impaired. This usually manifests as very poor oral language, especially when asked to describe something spontaneously. They often make grammatical and syntactic errors in sentence construction. This may or may not be accompanied by pronunciation difficulties.

It is also known as expressive dysphasia.

3. Language comprehension disorder

It is characterized by the child not understanding much of what is said to them, and by a significant difference compared to children of the same age. It is usually associated with an expression disorder, which would lead to a mixed dysphasia.

When a disorder of expression or comprehension or both occur, these are situations in which speech therapy treatment must be implemented as soon as possible since, especially, language comprehension is the "food of intelligence", of cognitive development.

4. Acquired aphasia or Ladau-Kleffer syndrome

It is related to epilepsy. Therefore, I will not address this clinical eventuality. I will simply say that, in my clinical experience, I have observed language comprehension problems in patients with subclinical paroxysmal activity (without epilepsy) in the temporal and frontotemporal lobes on electroencephalogram who have presented with mixed dysphasia.

LEARNING DEVELOPMENT DISORDERS IN SCHOOL

1. TE of reading

When someone tells you, "I think your child has dyslexia," they're referring to this category. However, it's absolutely counterproductive to talk about possible dyslexia before the age of seven. That's precisely why countries with lower school dropout rates begin teaching reading at this age. In Spain, because "we're smarter," we expect students to start primary school already knowing how to read, without considering what developmental neuroscience confirms, the potential difficulties we might create for students who haven't yet acquired this cognitive ability, or the damage we might inflict on their self-esteem and motivation at school.

In reading disorders we can find phonological errors (errors in the reading of phonemes) and eidetic errors (errors when distinguishing certain phonemes or letters: e.g. d with b, q with p, etc.), in reading speed and reading comprehension, fundamentally.

Although we cannot make the diagnosisIf your son or daughter presents any of these problems, simply observing their progress is advised. If they are five years old and continue to have significant problems, speech therapy intervention is necessary, although without feeling overwhelmed, as these issues usually resolve themselves.

2. Spelling disorder

Regarding the prognostic importance at this stage of learning, I refer to what was said earlier with respect to reading.

It's important to keep in mind that when there's a problem with learning to read, it's usually associated with dysorthography. In fact, in France, reading and writing difficulties are often studied together with spelling problems; hence the term "reading and writing difficulties." dyslexia – dysorthography.

Spelling mistakes are also often associated in some cases with dysgraphia (alterations in the writing of the grapheme).

3. Calculation disorder

When assessing a student with reading and writing difficulties, it is imperative to also evaluate their calculation skills. This is for two reasons. First, because these two difficulties are very frequently associated. Second, because it is common to encounter other executive function difficulties, such as attention and working memory, which can negatively impact calculation skills and learning in general.

4. Mixed learning development disorder

Its name defines it well. We speak of a mixed disorder when we find students who present with associated reading, spelling, and math disorders.

Despite being a "residual" category, it is the most frequent reason for consultation. In addition to these specific difficulties, it is very common to find impaired executive functions, including attention and organizational skills.

Furthermore, the aforementioned cognitive profile leads many professionals to prescribe psychostimulants as treatment, which will not have an effect on specific learning disorders, although it may improve attention deficit.

Before prescribing psychostimulants, we should consider the age and severity of the condition (benefit/risk). In girls, especially, prescribing psychostimulants in these cases can produce a hyperconcentration syndrome that would worsen attention difficulties.

Hence, in these neuropsychological situations, I do not recommend psychostimulants before the age of six/seven and after assessing whether the attention deficits are part of the difficulties of the specific disorder or of an inattentive subtype of ADHD.

5. Developmental disorder of written expression

Just as there is a speech disorder, the WHO describes a written expression disorder. However, it is usually associated with other learning difficulties at school. Therefore, a comprehensive evaluation should be carried out starting at age five.

6. Psychomotor development disorder

It is a more common neurodevelopmental problem than is generally believed. It is rarely considered in schools. These children, especially boys, are often clumsy in their motor skills. They are very poor athletes and have difficulties with tasks requiring motor coordination. They may present other symptoms that suggest this disorder: choreic movements, adiadochokinesia or mirror movements, and the presence of soft neurological signs (including undefined auditory, ocular, and peripheral lateralization) that usually improve with neurodevelopment.

They can affect fine and/or gross motor skills and are usually associated with difficulties in school learning.

In some academic settings, when they are associated with other learning and attention problems, it is often called DAMP: Disorder of Attention, Motor Control and Perception. If it is associated with a mixed school learning disorder, it was formerly also known as Minimal Brain Dysfunction.

We will not address the TE of mixed developmentbecause it is a category that is scarcely evaluated and whose validity as an autonomous clinical entity is poorly tested.

RECOMMENDATIONS FOR PARENTS

1. Don't despair. We are talking about a very changeable stage of neurodevelopment and about which there is a great difference between children without us being able to speak of anomalies.
2. For the purpose of being didactic, we are going to present several scenarios and what to do in their presence.

- Presence of a language delay: They are quite frequent, especially the dyslalias. If the problems persist beyond three and a half to four years of age, speech therapy should be started. They usually respond very well to treatment, and there's no need to worry.

If there is an alteration of the expression and/or compression In cases of language difficulties, the situation is more concerning, and speech therapy should begin at age three. Intervention should focus on improving language comprehension, as this is fundamental to the child's cognitive and social development. Close monitoring is essential, and comprehension should be improved as much as possible before the start of primary school. If the problem persists after starting primary school, speech therapy should continue for as long as necessary.

If your child has dysphasia (expressive/compressive or mixed), some tests must be performed Auditory Brainstem Evoked Potentials and an EEG.

– Presence of a language and motor development delay. In these cases, you shouldn't wait. There are pediatricians, child psychiatrists, psychologists, and teachers who downplay the importance of this situation and recommend waiting, saying, "They're still very young." In my opinion, when a language delay coincides with a motor development delay, intervention should always begin as soon as possible.

- Difficulties with reading and writing. Although these difficulties worry teachers and distress parents, in early childhood education the most prudent approach is to wait, which doesn't mean we shouldn't monitor their progress. We can't speak of dyslexia as a clinical diagnosis until the age of seven. If a child is five years old and shows markedly significant difficulties compared to their peers, speech therapy could be considered to improve their development and, especially, to prevent the child's self-esteem at school from being negatively affected. I want to emphasize that the important thing at this age is prevention and support for the child, not diagnosis.

– Usually, the Mixed Learning Development Disorder Learning difficulties are often identified during the second cycle of preschool. These children have clear challenges in several areas of learning, and therefore, we should begin providing educational support from the age of four. It is recommended to address those areas of weakness that are most relevant to their later learning.

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