Behavior: TIMED TESTS POSE A CHALLENGE

Q.A very smart 7-year-old girl in my practice has difficulty taking timed tests in school. Also, she is able to spell complicated words but sometimes has problems spelling simple words, such as “the,” and may spell the word backward. What could explain these difficulties?

Nivedita More, MD Mission Viejo, Calif.

A. Several possibilities come to mind. She may be a very deliberate, methodical, and perfectionistic student who is fearful of making a mistake if hurried. Test anxiety is another possibility. Or, she may be anxious for some other reason. If the problem is secondary to dysgraphia or difficulty with handwriting, evaluation by an occupational therapist would be helpful. The fact that this girl spells some words backward likely represents a neurodevelopmental variation that can be normal up to 8 years of age.

Morris Green, MD

DR. GREEN, is Perry W. Lesh Professor of Pediatrics, Indiana University School of Medicine, Indianapolis, and a member of the Contemporary Pediatrics Editorial Board.