At age 6 years (finishing kindergarten or starting first grade), a child has mastered the simple skills needed for an academic base. Children at this age demonstrate a transition from "preoperational" thinking to "operational" thinking, as described by Piaget. Preoperational thinking is characterized by magical and egocentric thinking. The child who has preoperational skills is very centered in his or her perspective and finds it difficult to understand that other people can look at things differently. In contrast, concrete operational thought is characterized by the ability to consider multiple variables, understand serial relationships (alphabet, word formation) and classification systems (handedness), and perform mental operations relating to objects (counting). Accordingly, the child described in the vignette most likely knows her right hand from her left. 

Most 6-year-olds do not yet have the visuomotor coordination to hit a baseball, although they may be able to play t- all. These children may be able to obtain a drink or open a packaged meal, but they cannot yet organize and cook a meal. Letter formation is still awkward at this age, with large letters. Reading is primarily by word recognition, although 6-year-old children may be starting to use phonetics. 

Developmental evaluation should be included in health supervision visits at this time to assess a child's school readiness and probability of academic success. Verbal skills and general knowledge can be appraised through general questions such as "Where do you go to school?" and "What is your telephone number?". Asking the child to copy a cross (4- ear-old), square (5-year-old), triangle (6-year-old), or diamond (7-year-old) can evaluate handedness, graphomotor skills, and visual-perceptual skills. Asking the child, "What makes the sun come up in the morning?" and "What really happens to the people on television who fly or get hurt?" can assess his or her beliefs regarding causality and capacity to distinguish between reality (concrete operational thinking) and fantasy (preoperational thinking).

References:
Dixon SD, Stein MT. Encounters With Children: Pediatric Behavior and
Development. 3rd ed. St Louis, Mo: Mosby, Inc; 2000
Piaget J. The Origins of Intelligence in Children. New York, NY:
International Universities Press; 1952
Smith PK, Cowie H. Understanding Children's Development. 2nd ed.
Cambridge, Mass: Blackwell Publishers; 1991