Support for Chapter 9

Screening and Surveillance with Older Children

The risk for developmental-behavioral/mental health problems increases throughout a child’s life. We cannot stop at 24 or 30 months in our efforts to detect problems. Language problems, learning disabilities, and mental health problems emerge later in life.

We cannot depend on schools to identify all problems—many challenges are subtle for starters. Next up ask yourself: If you had 25+ children in your exam room at the same time, how adept would you be at detecting difficulties? Teachers and parents (and students) need the help of health care providers who are best positioned to scrutinize an individual child.

So Chapter 9 describes what we should be doing with school age children. We include below a number of  downloadable files but please note that all measures are included (laminated) in PEDS:Developmental Milestones.

  1. How to obtain and analyze existing test scores generated from the (often annual) administration of group academic achievement tests at school). This approach is preferred because such tests provide indicators of skills in all areas (e.g., science, spelling, reading comprehension) and are thus far more detailed than what can be measured in pediatric clinics. Included here is a records release request you can download, personalize, and send to schools (or give to parents to facilitate information sharing).

  2. If school test results are not available we provide downloadable versions of two measures that can be easily used in busy clinics:

    1. A short measure of academic achievement [The Safety Word Inventory and Literacy Screener (SWILS)] and scoring instructions.

    2. A measure of mental health, the Pictorial Pediatric Symptom Checklist-17 in English and Spanish. The Pictorial PSC provides indicators of depression/anxiety, conduct, and attention problems. With scoring instructions for both.

      Too often we jump straight into diagnosing ADHD when, in fact, attention difficulties can be a symptom of other kinds of mental health problems, and/or academic deficits (e.g., if the work is too hard for a child, it is difficult to pay attention). So, we encourage use of the above tools (or use of school test data) before jumping into an ADHD diagnosis and medical treatment such as:

    3. The Vanderbilt ADHD Diagnostic Rating Scale in English and Spanish along with the Teacher Report Form of the Vanderbilt in English and a cover letter to teachers, along with scoring instructions.

    4. Next up we include a downloadable permission form for administration of medications at school.

    5. Finally we include a list of resources for helping school age children (e.g., where to make referrals, how to find after school tutoring assistance, etc.).

Links to Resources for School-Age Children

When recommending evaluations for school-age children, call the school psychologist or speech-language pathologist in the child’s school of zone or school district.

Click here to locate mental health services.

Click here to find social services including domestic violence, child abuse and neglect, adoption, state, and local services, etc. can be found at

For after school programs and homework help, check with the student’s school of zone, and also visit the websites of the Boys and Girls Club and the YWCA

For guiding parents and adolescents in how to help students who struggle in school, visit the Nobody’s Perfect site and Kids Health

Finding private tutoring is usually via “word of mouth.” Teachers can often identify local tutors who can help with the curriculum used by each particular school. Although there are national tutoring services (e.g., Sylvan Learning Center) these tend not address specific curricula, to have large class sizes, and are generally more expensive and less effective than individual tutoring.

Avoid visual therapies (e.g., Erlen) or other optometric (or chiropractic) interventions. Reading problems are not caused by visual difficulties and jumpy saccadic eye movements (given appropriate acuity). Instead, most reading problems result from challenges associating sounds with letters or from insufficient language development—meaning that children, once they have learned to read, still have trouble “reading to learn.”  If parents are invested heavily in such therapies, simply suggest adding a referral for testing by the schools and/or tutoring in reading.