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  Medical Examination of School Entrants at Waldorf Schools

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By: Karl-Reinhard Kummer
The examination of entrants is one of the most important functions of the school doctor. The way it is done differs from school to school, and there is also a difference between the functions of the teacher and the doctor. The examination above all has to determine if a child is ready to start school in body, mind and spirit, and to diagnose any existing physical defects. The central issue is usually if the right level of development has been achieved, for a child's progress at school and the whole of his or her development in the second and third seven-year period will be affected by determining the right time for starting school. Excessive demands are made on children who start too early, whilst children who are too old for their class are not sufficiently challenged and tend to get bored.

Some people joke about "kindergarten leaving exams", but it is true to say that children must have certain abilities if they are to go to school. The issue cannot, however, be decided on test results. Nickel (1) has gone into considerable detail in his critical assessment of school entrants' examinations. For school doctors at Waldorf schools, the key criterion is the overall impression of the child's etheric development. Individual parameters merely help the doctor to arrive at an assessment. This means of course that the examination may take a completely different form from the example given in this paper.

One particular method
The moment when one first meets the child is particularly important. Bockemuhl summed this up in two questions: "Where do you come from?" and "Where are you going?" (2) Other questions are: "How does the child cope with a new situation?"

"What degree of independence has developed?" It is sometimes possible to know at first sight what the constitutional type is, and the same often applies to the level of physical development. The significance of that first moment in the threshold situation of coming of school age cannot be underestimated.

The child may be asked to undress whilst the history is taken. This provides an opportunity for quiet observation of finger dexterity in undoing buttons, balance and perseverance.

The physical examination which follows provides basic orientation '" regards height and weight. Particular importance attaches to dental development, level of physical development and failure to achieve development targets for the first seven-year period, e.g. undescended testes. Dominance is another important aspect, e.g. laterality of eye and ear, hand and foot, and visual and hearing function. To determine visual dominance, children are asked to look through a kaleidoscope. The dominant ear is the one to which they will take a ticking clock to hear it ticking. Red / green color chart test and stereo test demonstrate perception of more complex forms.

Motor function is assessed by letting children hop, balance, be a jumping jack and use a skipping rope. A ball is thrown a number of times, with particular attention paid to the way the child prepares to catch or throw the ball.

Preparatory emotional movements of the face and other movements indicate the extent to which the child is inwardly in control of the process. With children who are over six years of age, the attempt may be made to bounce the ball on the floor. Ii the child is cooperative, this will quickly give basic orientation on motor function, so that one has key information on his or her readiness to start school. Laterality of hand and foot is assessed at the same time. The child is then asked to get dressed. The school doctor writes notes in the meantime and observes the child's behavior whilst dressing.

After this, drawing and finger dexterity can be studied in more detail. At the Waldorf school of Karlsruhe in Germany, this is the teachers' job. The school doctor can however gain important information from observing children as they draw zigzag lines, wavy lines or meanders, for this is where the first signs of later perceptive disorders may show themselves. Ideally children should be allowed to draw a complete picture during the examination, but time does not always permit this.

Metamorphosis of etheric forces
The physician determines it the inherited body of the first seven-year period is undergoing metamorphosis, thus providing the necessary preconditions for an awakening of powers of thought and of memory. Steiner frequently referred to the metamorphosis of powers of growth (e.g. 3, 4):

"It is of the greatest possible importance to know that the ordinary powers of thought in human beings are in fact the refined powers of growth and form." (3)

Marti(5) differentiates etheric forces into powers that generate form and figure, powers that generate lite and powers that generate substance. Below, an attempt is made to relate the phenomena seen when children are ready to start school to their thinking, feeling and volition.

The changes in proportion that come with physical development can be seen as belonging to the powers that generate form and figure. The developing feeling for time and space and for rhythm and beat, and the developing powers of thought relate to the powers that generate life. It appears that the powers that generate substance no longer play any appreciable role when the changing of the teeth takes place.

I. Changing of the teeth and changes in physical proportions

The phenomena are generally grouped under the headings" changing of the teeth" and "physical development" (see 6). At the examination of school entrants it is important to know if these changes have started.

1. The changes in dentition are immediately obvious. Some children have lost their front teeth as early as the sixth year or thereabouts. This essentially relates to their sensory faculties. The appearance of the aptly named "sixth-year molars" is more important. As the teeth come down, changes in the facial skull become possible. Children whose teeth develop late often are late in coming awake in the life of thought and ideas.

2. A physical middle develops as the middle sections of different parts of the body begin to grow: In the head, the nose and paranasal sinuses are enlarged. They develop in the space between the frontal and maxillary parts of the skull. In the trunk, the thorax is elongated; from the 9th year onwards its curvature increases. The diaphyses of the long bones in arms and legs grow, resulting in elongation of the limbs. Differentiation of epiphyses and diaphyses is beginning.

3. The body parts grow more distinct: head, trunk and limbs are more clearly defined compared to the earlier general roundness of the body.

4. The last remnants of reflex motor organization should have gone, e.g. reflex spreading of the hands when walking on tiptoe. The head is achieving a balanced position. The limbs grow mobile relative to each other and the trunk. A number of simultaneous movements can be made, e.g. in aiming a ball. Mobility of the trunk begins to hold a middle position between the resting position of the head and the mobility of the limbs. Much of this can be observed when first saying hello to the child.

5. Some school doctors use the changes in heart sounds in their assessment of physical maturity. (7)

II. Will development

One of the signs of being ready to start school are changes in the will. The morning verse for the first four classes includes the line: "that I can work well and be keen to learn." Pleasure in learning and in new things is one of the signs that children are ready. Children may be introduced to something new during the examination. Some will learn to skip the rope, for instance, and go home very proud of the new skill they have acquired. It is however advisable to be careful when there is a likelihood of the child not being ready for school.

When children are ready to start school, their powers of will are less exclusively directed to physical development, and begin to be addressed to the outside world. Until the child is ripe for the earth, however, these powers will be essentially receptive, so that the inner life of the child follows events. It is important that the life of ideas enters increasingly into the will sphere (see 8).

At the same time, powers of will are increasingly entering into the life of thoughts and ideas. This shows itself in perseverance. You only have to watch children undressing to see if they have developed perseverance or need to be reminded to keep going. Many children lack perseverance at this stage, even if clearly intelligent.

III. Emotional development

a) Feeling for, and awareness of, space
When children are ready to start school, sensory perception is transformed at the level of the lower senses. This is evident from a child's relationship to space when it enters the room. Children who walk in with heads held high are probably ready. They are fully aware of the space they are entering and feel at home in it. Shy children will often need more time to get used to things, however, and the physician should therefore be cautious in coming to a conclusion.

Awareness of space is evident in movement: A jumping jack can only be produced if there is awareness of the space behind. Children who are not yet ready for school will usually move rather as if squatting, with arms and legs in front of the body. This keeps the movement within their field of vision. Children who are ready for school are beginning to develop awareness of the space behind them and are able to do the exercise standing upright and moving in the vertical plane lateral to the body. More or less the same is seen when a skipping rope is used. The posture of children who are not ready for school is slightly squatting and tensely bent forward. They cannot yet manage the rope. Once they are ready for school they are able to visualize the movement of the rope when it is behind them, and one sees the way they manage the rope when it is behind them. Hopping also serves to indicate control of the space behind. Children ready for school are able to jump backwards whilst looking forward.

b) Feeling for rhythm and beat

With the changing of the teeth comes a change in the way children relate to rhythm and beat. "There is a difference in the way children relate to rhythm and to beat before the changing of the teeth and afterwards. Before, rhythm and beat were things children would imitate but transform into sculpted, modeled form. Afterwards they are transformed into an inner musical element." (9)

Rhythmic elements come whenever there is repetition. Children ready for school will happily and voluntarily go through repetitions, e.g. when doing the jumping jack. Those who have the energy will do it five or six times in succession, even though they were only asked to do it once. 1bis may be seen as a short melody. It is possible to see that the musical faculties have been freed and come to expression in the child's movements.

Rhythm is needed for skipping the rope, for hopping and for throwing a ball. The school doctor has to establish if motor weaknesses are due to lack of maturity or to coordination problems.

Rhythmic musical abilities are also used in some drawing exercises: zigzag line, simple waves, meanders and angular meanders. Children who merely copy the individual elements of these loose track; they then do not know how to go on or start to invent their own "patterns".

It is possible to relate patterns that are often used at the Waldorf school in Karlsruhe to different beats: a simple zigzag to duple time, simple and meandering waves to triple time and the angular meander to quadruple time.

 Rhythm can also be observed in speech. School children demonstrate this by the use of emphasis, more or less like the intermediate hop when hopping. Every emphasis or attempt at emphasis may be seen as a rhythmic element.

IV. Powers of imagination and thought

1. Memory and imagery
The ability to remember is a precondition for the power of thought. In preschool children, memory is associative; school children begin to have an idea of time and sequence. During the first seven-year period, children have usually remembered from habit, immediately forgetting again. Ask a preschool child, "Where did you go yesterday?" and the answer may be, "On holiday." The holiday was three months ago, and yesterday the child went to the zoo. Say, "Oh, but we went to the zoo yesterday!" and the child will remember one association follows another. School children have visual memories and would recall a walk as a sequence of images. It has to be said, however, that many preschool children have already had memory training, so that the ability to remember cannot be used to indicate readiness for school.

Children now are able to visualize things in their thinking. School children know how something looks or should look if it is right. This is evident even with a simple test type chart, and with the stereo test and color chart tests, too, children will not just see "something" but want to identify forms and figures correctly. A child who is ready for school may prefer to wait before giving an answer rather than give the wrong answer.

2) The question "How"
School children always ask "how?" If asked to hop, for instance, they will ask if they should hop on one or two legs. It is also possible to observe how children follow events, for instance when a ball is thrown to them. They will try to throw it back the way the adult has thrown it to them. It means that they are no longer focused in themselves when thinking, but on the object or person under observation.

Something as simple as throwing a ball will show if children merely throw it away from themselves or towards a goal. The first of these may be called "throwing per se". Children who aim the ball are focusing on the goal and are no longer centered on themselves.

The same is seen when children catch a ball. Children who are ready for school will inwardly follow the activity of the thrower and will have "caught" the ball in their mind the moment it is thrown (anticipation).

The handling of "tools" also serves to indicate how far powers of thought have come free and are ready to be involved in the world around the child. Children who shorten a skipping rope to the right length show capacity for thought.

Task-orientated skills can also be observed when children draw or paint, by noting how they use the space on a sheet of paper. The essential point is that children should have an idea of how to proceed.

3) Correction of mistakes knowing the "right" way
Children therefore correct their mistakes. If they are ready for school they will try and do things the "right" way and in accord with the given situation. They begin to note their errors and correct them, e.g. throwing the ball better and more accurately each time. When copying forms, they'll go over a line again to improve it.

Children now have an idea of what the previous throw or the original drawing was like and what they should be like. Children who correct their mistakes have an inner image of the process. They are able to get to the essence of things.

This can also be seen when children make their first attempts at clapping their hands to a given rhythm or sing a tune they have heard. They begin to be able to enter into a form in their minds.

4) New experiences
Much can be learned from anything that is new to children. If you let the ball bounce on the floor, children who are not ready for school will be surprised. They do not expect it to bounce, not even if you have told them what you are going to do. Children who are ready for school will have an inner image of the likely flight path. It is only after the changing of the teeth that children begin to grasp the reality of things they perceive and the ideas that are connected with them (see 10).

Before the changing of the teeth children can be seen to perceive things without being able to think them. They will follow the flight of a ball without being able to "calculate it in advance" and reach for the ball itself and not the point where it may be expected to be. If they manage to catch the ball this is due to habit and training but not to being able to follow the flight in their mind.

5) Simultaneous events
Children are now able to do several things at once: skipping rope they are able to swing the rope and jump. The same holds true for things that go in the opposite direction, e.g. the combination of curves and straight lines crossing in opposite directions in a figure 8. Five-year-old preschool children can do simple crosses, but it demands a great deal more to draw the figure 8. We can also ask children to walk the figure. This will show if they have an inner idea of the form, but in many cases this is asking too much. Meanders also involve movements going in opposite directions.

6) Themes in children's drawings
Certain themes tend to come up almost every time in pictures drawn by children: The front-door knob, curtains in the windows, a flowerpot on the window sill and, with boys, the steering wheel in the car. Children represent the complete world they feel it ought to be.

7) Speech
It is only possible to refer briefly speech becoming free at school age (see 11). Children can now be reached through speech. When they are ready for school they will obey requests made in words only, without accompanying gestures, e.g. to put their feet side by side. Prior to this, adults had to use gestures or their hands to guide the children.

At the medical examination of school entrants, the physician establishes how far etheric forces that have been active in physical development have become free, so that there are changes in thinking, feeling and will. This can be observed in certain phenomena that are revealed in a routine medical examination. It is a matter not of putting test questions but of gaining a general view of the etheric situation.

* Original German title: Die iirztliche Einschulungsuntersuchung in tier Waldorfschule, from Der Merkurstab 6/91, pages 442-448. English by Anna R. Meuss, FIL, MIT!.


1. Nickel H. Das Problem der Schulreife, Eine systematische Analyse und ihre praktischen Konsequenzen. In Karch D, Michaelis R el al. (ed). Normale und gestorte Entwicklung. Heidelberg, New York, Tokyo 1989.

2. Bockemiihl J. Personal communication. School doctors' conference 1980.

3. Steiner R, Wegman 1. Fundamentals of Therapy. Tr. E. Frommer and J. Josephson. London: Rudolf Steiner Press 1983.

4. Steiner R. Spiritual Science and Medicine. London: Rudolf Steiner Press 1975.

5. Marti E. Das Atherische. S. 108 ff. Basel 1989.

6. Vereinigung der Waldorfkindergiirten. padagog. ForschungssteIle Bund der freien Waldorfschulen. Mathiolius H. (ed). Die Bedeutung des Zahnwechsels in tier Entwicklung des Kindes. 2. Aufl. ohne art (Stuttgart) (with 32 relevant texts from lectures and books).

7. Schinkel J. Personal communication.

8. Steiner R. Study of Man. General Education Course. Tr. H. Fox, A.c. Harwood. London: Rudolf Steiner Press 1981.

9. Steiner R. Soul Economy and Waldorf Education. Tr. R. Everett. New York: Anthroposophic Press 1986.

10. Steiner R. The Philosophy of Freedom. A Philosophy of Spiritual Activity. Tr. R. Stebbing. London: Rudolf Steiner Press 1989.

11. Steiner R. Human Values in Education. Tr. V. Compton-Burnett. London: Rudolf Steiner Press 1971.

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