In a message dated 2/4/99 2:18:11 AM, writes: << 2) A five y.o. child came in for a school physical. The mom points out that she often will write names backwards "NHOJ" for "John". However, with time, she's been starting to write "correctly". In my presence she wrote her name correctly. Does this warrant a referral for dyslexia or some other form of learning disorder? (I've been unable to find anything definitive on this symptom, and I thought I'd wait until my supervising returns next week and run it by him then...) >> This is my take on that small bit of info: First, 5 year old are just learning to write and often make lots of mistakes, such as letter reversals, while learning. Writing is a complex task that requires perceptual and visual memory skills as well as fine motor/graphomotor skills and takes time and practice. Most 5 year olds are just learning to write their own name, much less write someone else's name. The parents seem to have unrealistic expectations here. An 8 or 9 year old who still can't write d and b correctly, etc. might have a problem. Second, in kids of any age, you can't make a major diagnosis, i.e. learning disability, on the basis of a single isolated finding. Many parameters have to be abnormal based on norms for age, and it's best to used an instrument with good reliability and validity (i.e., which yields a score which is compared to norms). These tests are usually administered, scored and interpreted by people trained to use them, like school psychologists. BUT--I would not refer the child you speak of for testing unless they had significant delays in many areas. For a 5 year old, that might consist of several (not just one) of the following: not knowing colors (while having normal color vision), not having a concept of number (how many fingers am I holding up?), being unable to master using scissors, being unable to copy simple shapes like a square, having unintelligible speech or making significant grammar errors for age, not having a digit span of 4 forward, etc. Third, "dyslexia" is not a diagnosis per se. It's an obsolete term which only means: inability to read. It doesn't refer to letter or word reversals. Letter or word reversals, as mentioned above, are only a symptom, like "swollen glands", or "fever". The most important piece of information you can ask the parents for to give you any idea whether there's a REAL problem, rather than get hung up on the letter/word reversals, is "What grade level is the child reading on?" (The same with math skills). This is information the classroom teacher can provide. Within the grade level is the month of the grade, f'rinstance, 4th grade, 3rd month. If a child in 3rd month of 3rd grade is reading at 1st month of 2nd grade, I encourage to parents to get to the root of the problem. (and it might not be learning disability, it might be the parents were going thru separation and divorce when the child was in 2nd grade--but that's off on a tangent. . . ) Of course, there is no Kindergarten reading level per se, Kindergarten is pre- reading or early emergent reading towards the end--in most school districts. Kindergarten's purpose has traditionally been to help the child learn to function in a group, delay gratification and learn to be regimented (line up to go to another part of the school; leave the playground when the whistle blows; fire drills, etc.) and to some extent, practice recognizing and writing numbers and letters. It's premature to have so much concern about academic achievements when these are not expected until First Grade. In your place, I would suggest the parents bring their concerns to the teacher, and ask the teacher if the child is meeting expectations for age and grade. He/she should be able to reassure them. Stephanie Walker, RN, FNP