Development of 4-year-old

[Larrytest]

Dr. Kennedy,

Hi. Our son is about a month away from his fourth birthday. Physically he's terrific -- runs and speaks well, can eat with a fork and (to add a bit of levity) can use the DVD player better than his parents. Yet we've got two concerns that we don't know how to approach. First, he goes to pre-school 2.5 hours a day. His teachers say he is nice but he rarely plays with other children -- he'll pretty much sit on his own and run a toy truck back and forth, or go out to play on the slide. Second, at home he sometimes repeats a phrase off and on, and doesn't answer some questions directly. He'll correctly answer when you ask his name, or his colors, or if he needs to use the potty, or if he'd like to play outside. But then sometimes he'll refuse to answer, or use a nonsequitor that confuses us.

He was evaluated by a team about six months ago and found to be intellectually on target, but his fine motor skills (like stacking blocks, or putting together a puzzle) were way behind the norm. (His school is providing a special teacher to work with him on these skills twice a week). But recently his pre-school teachers wondered if, based on the above concerns, he should have neurological testing.

As a nonprofession in this area, I see him as a bit lagging in some areas and as overly shy (as I once was), but otherwise smart, clever and able (he even jokes with me often at bedtime, when we read, and has a very good memory). My wife is a little more worried, especially about the nonsequitors. I intially agreed to the neurological testing but am now worried that he might be misdiagnosed or labled.

In general (and I know it's difficult via the Internet), would you consider his development within a normal range? Do you have any advice on what to do or what to read?

Thanks so much.

[Larrytest]

Thanks for your quick reply. One mistake on my part -- it's neurological evaluation, I am told, done through verbal tests and observation. While I am still wary, I'll certainly try to learn more. I do agree that additional schooling would increase his comfort zone and help him to interact further.

We really appreciate your advice. Thank you.

[Kevin Kennedy, Ph.D.]

Without actually hearing his response to questions I cannot offer you much guidance about the replies that worry you. Having said that, nothing you describe indicates any need for neurological testing. Now, it is possible that someone thinks he needs neuropsychological testing (such testing looks with a fine tooth comb at a child's cognitive functioning), but at his young age I would not endorse such an approach. Overall I would let him continue as he is with the exception of increasing his exposure to the pre-school program. More hours would do him good. Shyness tends to be an inherited characteristic and it looks like the apple did not fall far from the tree in that regard. If any evaluation were to occur now, I'd opt in favor of a Speech/Language assessment.