key: cord-0025102-l4241w2t
authors: Lim, Sok M; Nyoman, Leanna; Tan, Ying J; Yin, Yun Y
title: Transition practice before entering primary school: A longitudinal study of children with and without special needs across a year
date: 2021-05-18
journal: Hong Kong J Occup Ther
DOI: 10.1177/15691861211013427
sha: 6b80626fe118b01e752d0a104f083b874da203da
doc_id: 25102
cord_uid: l4241w2t

INTRODUCTION: The transition to primary school is a significant milestone for children. Transition periods can offer new opportunities to build skills, relationships, and experiences that strengthen self-efficacy. In Singapore, parents play an important role in supporting transition as preschools and primary schools operate independently. Occupational therapists are involved in supporting children with special needs in transitions. OBJECTIVE: Focusing on the transition period of getting children ready for primary school, the objectives are (i) to learn about the strategies that parents used for the purpose of transition and understand the intentions behind what they do and (ii) to compare the transition practices and perceived school readiness between parents of children with and without special needs. METHOD: A longitudinal study involving 48 parents was conducted over 12 months. Parents completed a survey at the start and end of the year to detect changes from baseline, and semi-structured interviews every two months to gather their subjective experiences and track their child’s readiness for transition. The surveys and interviews were conducted on a mobile instant messaging platform. Coding of responses was guided by school readiness domains identified in earlier studies and Occupational Therapy Practice Framework’s approaches to intervention. RESULTS: Most parents focused on establishing and maintaining new self-help and academic skills across the year while few were “modifying” or “preventing”. Increasing trends in child readiness were noted for both children with and without special needs. CONCLUSION: In family-centred practice, it is important to recognise parents’ expertise and resources.

Transition to primary school is a significant milestone for children and their families. For children, these transitions include adjusting to new physical and social environments, and longer school hours which might cause significant changes to the family routine. A successful transition to school can be attributed to the child's ability to adapt to new environments and negotiate challenges to rapidly progress in their learning and development (Dockett & Perry, 2007) . By definition, transition refers to the period that involves the change of roles and expectations (Lim & Jones, 2017) and it begins with the preparation for the change to take place. Navigating these changes in roles and expectations, and in preparation for them, could prove this transition both exciting and challenging.

This transition period between preschool and primary school is crucial as success is associated with a lasting positive impact on the child's academic and social performance (Clarke & Sharpe, 2003) . One key factor in supporting a child in school readiness is collaboration between parents, preschool, and primary school teachers. Greater levels of adjustment, positive social competencies, and fewer problem behaviours are reported in children whose preschools maintain good levels of communication with the child's primary school teachers (Chan, 2010; LoCasale-Crouch, Mashburn, Downer, & Pianta, 2008) . To facilitate transition, preschools typically organise primary school visits to allow children to familiarise themselves with their new environment. Primary school teachers emphasize the importance of preschool teachers in sharing about primary one life with students and their parents (Choy & Karuppiah, 2016) . In other local transition studies, parents valued understanding their child's areas of weaknesses from the preschool teachers and establishing communication with the primary school teachers (Choy & Karuppiah, 2016; Clarke & Sharpe, 2003) .

In Singapore, although preschool is not compulsory, it is estimated that 97.5% of primary one children had attended at least one year of preschool education (Choo, 2010) . Singapore's Ministry of Education (MOE) recently enforced the implementation of a standardised curriculum framework for kindergartens in Singapore, which highlights 6 learning areas: aesthetics and creative expression, discovery of the world, language and literacy, motor skills development, numeracy and social & emotional development (Ministry of Education, 2012) . This framework guides preschools to focus on the holistic development of children and prepare them for learning in primary school. Additionally, parents are advised to support their child in social skills (e.g. developing responsibility and selfmanagement skills) and self-help skills (e.g. toileting and caring for belongings) to smoothen the transition to Primary One (P1) (Ministry of Education, 2018) .

Parents in Singapore have reported some common concerns and challenges preparing their child for primary school. First, parents are usually concerned about the changes in academic demands (e.g., English, Math) and self-help expectations (Choy & Karuppiah, 2016; Clarke & Sharpe, 2003) . While parents have the intention to support their child for school readiness, they also expressed difficulty in doing things with their child at home owing to a lack of time as most of them hold full-time employment (Clarke & Sharpe, 2003) . Lastly, Chinese-speaking parents are often worried about their ability to support their child's English language development and thus send their children for supplementary English classes (Choy & Karuppiah, 2016) .

Children with special needs (SNs) transit to both Special Education Schools and mainstream primary schools. According to Ministry of Education, there are about 32,000 students with SNs in Singapore (Choo, 2019) . About 20 per cent of these students, with moderate to severe needs, attend one of 19 Special Education schools in Singapore (Choo, 2019) . The remaining 80 per cent have mild learning needs and attend mainstream schools, including those diagnosed with dyslexia, mild Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder (Choo, 2019) . This figure suggests that when understanding about transition to mainstream primary school, it is important to include the perspectives of parents who have children with SNs.

Beyond the common concerns in getting ready for primary school, parents with children with SNs face additional challenges. A study done by Janus, Lefort, Cameron, and Kopechanski (2007) highlighted that children with SNs face a complex transition process and there are gaps in current process. The transition to school depends on the child's ability to adapt to the demands of an unfamiliar environment, including behavioural adaptations and rule acceptance, along with independent working and teamwork skills (Margetts, 2002) , which children with SNs face greater difficulty than their typically developing peers in managing (Janus et al., 2007) . Therefore, parents have additional areas to attend to when preparing children with SNs for primary school.

Teachers' willingness to work cooperatively with parents is regarded as one of the factors enabling a smooth and positive transition (Larcombe, Joosten, Cordier, & Vaz, 2019) . One potential barrier to the development of a positive relationship between teachers and parents of children might be stigma. For example, teachers may have preconceived notions about the challenges of working with children with autism (Larcombe et al., 2019) and disbelief about parents' perception of the extent of their child's needs (Connolly & Gersch, 2016) . Additional tension may be created when parents attempt to work with school leaders to resolve issues in school (Lee, 2014) . As a result, parents with children with SNs may sometimes be apprehensive in communicating with primary school about anticipated concerns.

While the literature has highlighted the benefits of close collaboration between parents, preschool, and primary school, the reality is that most preschools and primary schools in Singapore currently operate independently. Parents provide an invaluable link between the two phases of education for their children. In Singapore, while most parents and preschool teachers agree that academic skills are important for P1, teachers also emphasise that social, emotional, and self-help skills such as adaptability and selfsufficiency is important (Chan, 2012; Choy & Karuppiah, 2016) . Parents play an important role in preparing for these latter skills outside of formal preschool hours. It is therefore important to explore what parents are currently doing to facilitate their child's transition and their perception of their children's school readiness, in the transition between preschool and primary school.

This study aims to explore parents' transition practices, focusing on the transition period of getting their child ready for primary school. The study objectives are firstly, to learn about the strategies that parents used with their child for the purpose of transition and understand the intentions behind what they do. Secondly, to compare the transition practices and perceived school readiness between parents of children with and without SNs.

With better knowledge of parents' intentions behind these transition strategies, schools and professionals supporting children with and without SNs can work closely with families to fill the gaps. Additionally, this study can highlight the variety of strategies that can be recommended to prepare children for their transition to primary school. This study will be useful to occupational therapists in providing more targeted recommendation building on parents' existing foundation of knowledge in transition practices.

A qualitative study was conducted after ethical approval (Approval number: 2018126) from Singapore Institute of Technology's Institutional Review Board.

Mainstream preschools, childcare facilities, and Early Intervention Programme for Infant & Children centres in Singapore were approached. The study also recruited participants through word of mouth.

The inclusion criteria include:

• Parents whose child, in 2019, is enrolled in final/ second year of kindergarten (K2) • Parents can communicate in English • Parents must have a smartphone and access to internet Parents who have a child with clear plan for attending special school education were excluded from the study.

An online survey hosted on Qualtrics was first sent to participants to establish baseline demographic data and the concerns parents had about their child's transition.

Following which, short-semi structured interviews were conducted on WhatsApp every two months to collect and track transition-aiding strategies. The interview questions were derived from interview questions in earlier studies (Choy & Karuppiah, 2016; Clarke & Sharpe, 2003) with additional questions formulated to address the study objectives. The final survey was sent along with the final semi-structured interview on WhatsApp to detect any changes in concerns. Additionally, a Likert scale (ranging from 1 to 10) was used to track parents' perceived readiness of their child's transition to P1 at each contact point.

Confidentiality and consistency were ensured in a few ways; investigators used smartphones which were solely used to contact and interview the participants. Investigators calibrated their responses for the first five participants for the first interview conducted. Participants were also given periodic reminders to encourage responses. Participants who provided incomplete responses or none at all remained included in subsequent rounds of interviews until the end of the study, as they may choose to respond in more detail in the next round.

The use of smartphones is becoming increasingly common worldwide. They influence our daily routines, practices, and social interactions (Deuze, 2011) . It was found that smartphone users continuously attend to incoming message notification within minutes (Ganasegeran, Renganathan, Rashid, & Al-Dubai, 2017; Pielot, Church, & de Oliveira, 2014) . This could be useful in conducting interviews, hence worthwhile to explore its use in research.

Several studies from recent research on Mobile Instant Messaging (MIM) tools such as WhatsApp suggest that it is an efficient communication technology and provide data security through end-to-end encryption (Ganasegeran et al., 2017; Johnston et al., 2015; WhatsApp, 2018) . Furthermore, participants show preference for MIM in research over traditional face-to-face interviews (Oseni, Dingley, & Hart, 2018; Pimmer, Mhango, Mzumara, & Mbyundula, 2017) . This study adopted the use of WhatsApp and Qualtrics to conduct interviews and survey in view of the advantages MIM offer, allowing flexibility for parents to provide answers at a time most suitable for them.

Participants' deidentified data from the surveys and semi-structured interviews was uploaded onto NVivo 12 (QSR International Pty Ltd, 2018) to code and identify common themes and relationships between variables. Two weeks after each data collection exercise, investigators coded the data together to align coding.

A deductive analysis was employed used by coding data into pre-existing categories. Adapted from Choy and Karuppiah's 2016 research findings, the school readiness domains of "basic academic", "social", and "self-help" were used to categorise strategies that parents used to help their K2 child prepare for P1. The Occupational Therapy Practice Framework's (OTPF) (American Occupational Therapy Association, 2014) approaches to intervention was used as another lens to categorise strategies reported by parents. According to OTPF, approaches to intervention are specific strategies selected to direct the process of evaluation and intervention planning, selection, and implementation on the basis of the client's desired outcomes, evaluation data, and evidence. There are five approaches to intervention listed in the OTPF. Namely, "Create, promote health (health promotion)", "Establish, restore (remediation, restoration)", "Maintain", "Modify (compensation, adaptation)" and "Prevent (disability prevention)". Table 1 shows the description of OTPF's approaches to intervention and examples of strategies and served as a guide for coding the strategies reported.

NVivo 12 was used to code each strategy reported by parents. Strategies were coded into the school readiness domains of basic academic, social and self-help. Strategies that do not fall into any of the three school readiness domains were coded as "others". The codes were then sub-coded into the relevant approach(es) to intervention.

As shown in Table 2 , there was appropriate representation of parents with children with and without SNs. In Singapore, the Ministry of Education estimated that 2.1% of the total student population has disability (SPD, n.d.). In addition, parents were represented across different income groups and educational level.

During the bimonthly interviews, parents were asked about what they have tried to prepare their child for primary school. Figure 1 shows the frequency of strategies carried out across the year, differentiating between parents of typically developing children and children with SNs.

A total of 212 self-help, basic academic, social and other strategies were reported across the year. Of which there were 90 self-help strategies, 86 basic academic strategies and 11 social strategies. At 42.5% of all reported strategies, the self-help domain was most highly reported. It was most frequently reported in April and December. Basic academic was the second highest, with trend of decreasing frequency towards the latter half of the year. Intervention approach that does not assume a disability is present. Designed to enrich contextual and activity experiences that will enhance performance for all individual.

Organizing a play date Establish, restore (remediation, restoration)

Intervention approach to establish a skill or ability that has not yet developed or to restore a skill or ability that has been impaired Money management skills to prepare child for food purchase in canteen Maintain

Intervention approach to provide supports that will allow clients to preserve the performance capabilities they have regained, that continue to meet their occupational needs (assumes that without maintenance intervention, performance would decrease Continue training towards consistency and independence in toileting Modify (compensation, adaptation)

Intervention approach to finding ways to revise the current context or activity demands to support performance

Changing teaching style instead of scolding Prevent (disability prevention)

Intervention approach to address clients with or without a disability who are at risk for occupational performance problems Exploring school canteen with child to ensure food safety due to child's allergy Self-help strategies were the most frequently reported. Results indicated that both groups of parents established their child's abilities in similar ways, both with the intention of fostering independence and aligning their child's behaviour with school rules. These strategies include putting their child to bed earlier, teaching their child to pack their bag, purchasing food in public, and eating food within a certain amount of time, and participating in primary school visits with their preschool. Money management was one of the most frequently reported self-help skills practiced. Parents seem to be emphasising on their child's toileting skills at the start of the year in tasks such as asking for permission to use the toilet. Other toileting strategies included navigating public toilets to increase independence. Figure 2 shows the frequency of the various approaches to intervention implemented across the year. At 71%, establish & restore was the most frequently reported approach. Maintaining skills or abilities accounted for 19% of all reported approaches, create or promote accounted for 8%, and prevention at 2%.

Results suggest that the strategies and approaches utilised by parents with and without SNs children were similar for academic-related skills. Both groups of parents established skills through similar strategies such as sending child for enrichment classes, carrying out parent-facilitated learning activities and doing activity books. Their intentions were to follow their child's initiative and interest, meet school expectations, and build their child's confidence. Parents of children with SNs often made additional modifications when guiding their child, such as the use of a work and reward system. They "prevented" issues related to disability from happening by contacting the child's future primary school allied educator ahead of time, to ensure that the school is aware of their child's strengths and needs (e.g., behaviors and learning style) to set up a suitable learning environment.

This study tracked the overall readiness rating across the year through the use of a 10-point Likert scale. Results suggest that parents' perception of their child's readiness increased across the year as illustrated by the increase of a readiness mean value of 6 at baseline to an 8 at the final point. As shown in Figure 3 , the child's readiness for primary school improved and stabilised towards the second half of the year. Unsurprisingly, parents of children with SNs reported lower child readiness rating scores than their peers with typically developing children. A wider range in readiness values was also observed at each time point for this group.

The study indicated that both groups of parents focused on establishing skills. Of the other approaches to intervention, parents of children with SN also used "modify" and "prevention" in getting their child ready for P1. In the local study by Choy and Karuppiah (2016) , parents emphasised on basic academic skills during transition. In their study, preschool and primary school teachers urge parents to not only place emphasis on basic academic skills as self-help skills are equally important for children entering P1. In the current study, self-help was the most frequently reported by both groups of parents and they reported a range of strategies to help their child establish selfhelp skills. It was also found that parents reported a steady improvement of child's readiness over the twelve months.

Parents who participated in this study might have focussed more on self-help skills as they may have left academic preparation to preschools or enrichment centres. Based on our interviews, parents were aware of the importance of helping their child adjust to new routines and norms and had intentions of fostering independence. They acknowledged that unlike in preschool, P1 students would not typically be subjected to their teachers' constant attention, as they have to manage a larger class size. Additionally, P1 students are expected to take care of their own basic needs (e.g., toileting, caring for own belongings). The issue of money management was most frequently reported by parents. This could be due to how primary school students are expected to independently purchase food from the canteen, unlike in preschool where food is typically handed out to them. However, parents seem to find this issue manageable, as money management is an activity parents partake in daily activities, which they use as opportunities to educate their children. For instance, Parent A1 commented that "He's (Child) learning about money too. I get him to pay the Yakult auntie for our weekly Yakult". This suggests that once parents are clear with the intention to teach money management, they can easily create opportunities for their children to practice managing their finances through day-to-day activities. If parents are already practising such skills on a regular basis, it may not be necessary for professional involved (e.g, occupational therapist supporting child with SN) to use therapy time to address such skills, as they can be better achieved in real life context. It then frees up therapy time to address other goals.

One of the greatest concerns voiced by parents was the duration of their child's recess time. In primary school, the timetable usually consists of a recess break that last for 30 mins, excluding a five-minute snack time (Teng, 2018) . Parents were concerned that their children might not have enough time to finish their meals. However, skills such as time-management when eating is one that parents need to educate and train their children for.

Apart from time management, parents were also concern on their children's sleep-wake cycle, where they had concerns about the child's ability to wake up early. Typically, the primary school timetable is longer than in preschool (Koh, 2019) where parents' concerns lie in their child's ability to stay attentive in class. A more regular sleep-wake routine can also aid in child's self-help skills of getting ready for school in the morning. When parents have a clear intention to help their child get adequate sleep, they will build into the routine for a regular sleep-wake cycle.

In this study, the majority of the basic academic strategies reported were outsourced. A majority of parents enrolled their children in enrichment class(es). This finding is consistent with Choy and Karuppiah's study (2016) which shared similar findings.

In Singapore, every household has an average of 1.9 residents employed (Singapore Department of Statistics, 2018), and it is common to have both parents working. Hence, the lack of time could be the reason why parents are outsourcing their children's academic learning to enrichment centres. Unlike the abovementioned self-help strategies which could be embedded into daily routine, working on child's basic academic skills at home requires parents to set aside time after work with their child. Additionally, families in Singapore do value spending quality time such as having a meal, shopping, and exercising together (Ming, 2016) . Many of the strategies reported were in the self-care and social domains which suggested that parents might prefer leaving academic matters to tutors while they spend quality time with their child.

Another possible reason for parents to outsource basic academic strategies could be due to their lack of knowledge of the primary school curriculum. In this study, two mandarin-speaking parents reported that they sent their child to English enrichment class as English is not their primary language. Apart from the lack of knowledge of the curriculum, parents may also perceive enrichment classes as necessary to equip their child with equal competency in basic academic studies as their peers (Tan, 2017) . A study by Tan (2017) suggested that most parents in Singapore perceive enrichment classes as a means to promote equal learning opportunities and social mobility. In other words, parents perceive enrichment classes as necessary for their child to keep up with their peers.

Social skills are important skills to ensure a smooth transition to primary school (Besi & Sakellariou, 2019) . However, the results of study suggest that social skills were less emphasised than other school readiness domains. The few parents of typically developing children who reported social skill interventions tried reading books about transition to P1, or conversations about social situations with friends (e.g. teaching child about making friends and to speak up when bullied), and introducing their child to other future classmates. Parents of children with SNs brought their child to places (e.g. playground) to interact with others. Occupational therapists working with parents may have a role in ensuring social skills development is not overlooked and provide more strategies and suggestions in developing this important area.

It was somewhat surprising to the authors that both groups of parents reported very similar strategies in preparing their children for primary school. There were two main differences highlighted by parents of children with SNs. First, they made modifications such as work system, reward system. Second, to prevent new concerns arising, this group of parents communicated more. For example, by asking enrichment centre if the enrichment teachers could support their child before enrolment, contacting the child's allied educator in future primary school, to ensure they understand and can accommodate for their child's strengths and needs. Parents of children with SNs also identified communicating with their child and working with preschool teachers, early intervention centre teachers and allied educator as significant strategies to prepare their child.

Both basic academic and self-help strategies seem to rise and fall at similar time points. However, at the end of the year, there was an increase in reported frequency of self-help strategies. This could be due to parents' anxiety over child's self-help readiness for school. Parents reported that they attended school visits, adjusted child's sleep wake routine and engaged child in money management at the end of the year. Additionally, parents' perception of their child's readiness dropped between August to October. This is typically the period for P1 registration exercise. This readiness data showed that parents were typically more ready till the registration exercise period when readiness scores dropped. This could also be due to parents becoming more aware of skills required for primary school during the P1 registration period.

There was a reduce in basic academic strategy reported at the end of the year. This could be due to parents becoming more confident of child's academic readiness. There were more basic academic strategies reported at the first half of the year, with 58% of the total enrichment classes signed up across the year being reported during the early part of the year.

There were several limitations in this study. Firstly, the findings of this study may not be generalisable due to the small sample size and inconsistent response rate of some parents. While we attempted to descriptively present what the parents of children with SNs reported, we recognised it is not a fair comparison due to the small number. Additionally, the responses may be subject to recall bias as parents were asked retrospective questions. However, attempts to reduce the impact of recall bias was done through collection every two months. This study serves as a good starting point for future researchers to explore transitional practices in Singapore before starting primary school.

It would be interesting to find out the impact of activities that parents do to help their child transition to primary school. This current study looked at transition practice before entering primary school, focusing on the preparation. Future studies could extend the study period of transition practices from the last year of preschool to first six months of P1 to understand the issues faced at different time point of child's life. In addition, future studies can also look into including a larger sample of special needs children for better comparison with typical developing children. The use of Mobile Instant Messaging tools for longitudinally research presents rich opportunities for data collection to take place in a sustainable manner and in situations (e.g. CoVID-19 outbreak) where face to face meetings are restricted.

To ensure family-centred practice, occupational therapists must be aware of local transition practices and understand what parents are already doing and their intentions. In doing so, occupational therapists would thus be able to recommend strategies that build on their existing foundation of knowledge in transition practices. It is also important to understand concerns from their perspective and context, for example, worry about their child not finishing food in time for recess. Occupational therapists could also place greater focus on the OTPF approaches such as modify and prevent as these approaches may not be as intuitive to parents and are infrequently used. These approaches are especially relevant and important to parents with children with SNs, who may need to modify tasks that are expected of them. Furthermore, it may be important for OTs to consult parents on the topic of social skills, checking in on their awareness of primary school social skill requirements, or for any need of recommendations on strategies to build these skills.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Sok M Lim https://orcid.org/0000-0001-5041-180X

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education research, developmental disabilities, self-efficacy and resilience. She is also the Director of the Centre for Learning Environment and Assessment Development (CoLEAD) that looks after the faculty development programmes in learning and teaching at the university level

Leanna Nyoman obtained her bachelor's degree in Occupational Therapy at Singapore Institute of Technology in 2020

obtained his bachelor's degree in Occupational Therapy at the Singapore Institute of Technology in 2020

She is currently an Occupational Therapist at Thye Hua Kwan Early Intervention Programme for Infants and Children (EIPIC)

Sok M Lim is an Associate Professor in Singapore Institute of Technology, Health and Social Sciences cluster. She is interested in occupational transition,