Child Development II Flashcards
Boys @ 9-‐14 yo
Testes begin to enlarge, scrotal skin reddens and thickens
Pubarche in Boys
10-‐15, penis starts growing, so do you
Spermarche
12-‐16
Boys @ 12-‐16
SPERMARCHE! Peak of height spurt, facial and body hair begin to grow, voice begins to deepen, penis is done
Pubic hair growth completed (both boys and girls)
14-‐16
Thelarche
8-‐13, also begins growth spurt
Girls Pubarche
8-‐14
Girls @ 10-‐16
Menarche, adult stature, axillary hair, breast growth completed
Early Adolescents age range:
10-13
Early Adolescents Body Image
preoccupation w/self and pubertal changes, uncertainty about appearance.
Early Adolescents Peers
intense relationships w/ same sex friend
Early Adolescents Independence
less interest in parental activities
Early Adolescents Identity
increased cognition, increased fantasy world, idealistic vocational goals, increased need or privacy, lack of impulse control
Middle Adolescence age range:
14-16
Middle Adolescence Body Image
general acceptance of body, concern over making body more attractive
Middle Adolescence Peers
peak of peer involvement, conformity w/ peer values, increased sexual activity and experimentation
Middle Adolescence Independence
peak of parental conflicts
Middle Adolescence Identity
increased scope of feelings, increased intellectual ability, feeling of omnipotence, risk-‐taking
Late Adolescents age range:
17+
Late Adolescents Body Image
acceptance of pubertal changes
Late Adolescents Peers
peer group less important, more time spent in sharing intimate relationships
Late Adolescents Independence
reacceptance of parental advice and values
Late Adolescents Identity
practical, realistic vocational goals, refinement of moral/religious/sexual values, ability to compromise and set limits
Personality Development
The effect of a particular experience will be influenced by the child’s development, and the child’s temperament
will influence the responses of others in the child’s environment
Temperament:
The style with which the child interacts with the environment
What do variations in children’s behavior reflect?
A blend of intrinsic biologic characteristics and the environments with which the children interact
What is a Learning Disability?
Impairment in the acquisition and/or use of spoke (oral) language, written language (reading/spelling/writing) and mathematical skills. Characterized by academic functioning that is substantially below that expected, given the individual’s age, schooling and level of intelligence.
Types of Learning Disabilities:
Reading disorder
Disorder of written expression
Mathematics disorder
Learning disorder not otherwise specified
Learning Disability Risk Factors
Complications during prenatal/perinatal period, infections of CNS, traumatic brain injury, epilepsy, psychiatric disorder, chronic or debilitating health conditions
Family history: speech and/or language delay, difficulty learning to read or spell, grade retention, behavior problems or trouble in school, school failure
Learning Disability Management
Parent education.
Therapies and special ed targeted at child’s specific needs/deficits.
Special devices: hearing aide, orthotics.
Medications: specific target symptoms, outcomes.
Medical follow up.
What is the single greatest predictor of good outcomes for Learning Disabilities?
Early identification
Developmental Surveilence
Informal assessment of child’s development at each visit
When do we do Developmental Screening and Surveillance?
Every 9, 18, 24 or 30 months (general development) OR 18 & 24 months (autism)
5 components of Developmental Surveillance
- Eliciting and attending to the parents’ concerns about their child’s development.
- Documenting and maintaining a developmental history.
- Making accurate observations of the child.
- Identifying risk and protective factors.
- Maintaining an accurate record and documenting the process and findings
Developmental Screening
The administration of a brief standardized tool aiding the identification of children at risk of a developmental disorder.
Developmental Evaluation:
A complex process aimed at identifying specific developmental disorders that are affecting a child.
Developmental Screening Tools
Parental Eval of development @ 0-‐8y: To elicit parents concerns.
Ages and Stages @ 0-‐4y
Denver Developmental Test (tests motor function/adaptive
personality) @ 0-‐4y
Bayley Neurodevelopmental Screen @ 3-‐24 mo; assesses neural and developmental achievements.
Draw a person test @ 3-‐10y : estimates approx. mental age
Pediatric Symptom checklist @ 6-‐16y: looks into problem behaviors
Objective, physiologic methods are used for hearing screening:
Auditory brainstem response (ABR) and Otoacoustic emission (OAE)
Hearing loss risk factors:
- Developmental delay
- CNS infection(bacterial meningitis)
- Ototoxic medications
- Neurodegenerative d/os
Communication Disorders
Expressive and receptive language d/os
The defining features of spoken language disorders are:
Impairments in oral expression and/or listening comprehension associated with dysfunction in one or more subdomain of language, including: 1) morphology (word structure) 2) semantics (word meaning) 3) syntax (sentence structure)
Deficits must significantly interfere with academic achievement and/or social communication
Causes of Speech/Language Delay Disorders:
Significant hereditability, bilingual households, Otitis media
Global Developmental Delay:
Significant delay in 2 or more developmental domains: Gross/fine motor, Speech/language, Cognition, Social/personal
Intellectual Disability Etiology:
Genetic, Teratogenic toxins, Infections, Traumatic, Deprivation, or Idiopathic
Intellectual Disability Clinical presentation:
1) Deficits in intellectual functioning: IQ 2 SD below mean (70-‐75).
2) Deficits in adaptive function: ie: conceptual skills (money, time, self-‐direction), social skills (including ability to follow laws), practival skills (ADLs, IADLs)
3) Disability originates in the developmental period
Typically present with SPEECH DELAY (also hyperactivity and behavior problems)
Intellectual Disability Diagnosis
Dx: cognitive and adaptive skills (standardized tests), strengths and needs (5 dimensions), supports and services needed
Intellectual Disability (ISP) Classifications:
Mild (IQ 55-‐69)
Moderate (IQ 40-‐54)
Severe (IQ 25-‐39)
Profound (IQ <24)
Mild Disability:
(IQ 55-‐69; Intermittent need for support): Learns to read at 3rd–6th grade level, learns at ½-‐2/3 normal velocity; Usually lives independently, often marries
and parents, job competitive.
Moderate Disability:
(IQ 40-‐54; Limited need for support): Learns at 1/3 to ½ normal velocity, 1st-‐3rd grade reading level; ADL skills teaching, lives in supervised group home, rarely marries or parents, sheltered employment
Severe Disability:
(IQ 25-‐39; Extensive need for support): Learns at ¼ to 1/3 normal velocity, sight reading, life skills class, will likely need assistance w/ ADLs; Highly supervised group
home, does not marry or parent, sheltered work is possible
Profound Disability:
(IQ <24; Pervasive need for support): Learning less than ¼ normal velocity, no reading skills; Life skills in hospital, needs assistance w/ ADLS, often co-‐existing
medical conditions.
Risk Factors for Intellectual Disability:
Most common genetic cause: Down syndrome
Most common inherited cause: Fragile X syndrome
Most common medical cause: Fetal Alcohol Syndrome
Prenatal/Perinatal Causes for Intellectual Disability:
Maternal illness, infection, malnutrition; Toxins, teratogens, alcohol, illicit drugs; Chromosome abnormalities; Decreased fetal movement, IUGR; Perinatal asphyxia (Apgars of 0-‐3 at 5 minutes); Perinatal seizures; Prematurity
Post Natal Causes for Intellectual Disability:
Meningitis, encephalitis; Seizure disorder; Traumatic brain injury; Acquired metabolic and endocrine disorders; Severe chronic illness; Malnutrition; Child abuse and neglect; Adverse psychosocial factors
3 core features of autism spectrum disorders:
Abnormal social interactions, atypical communication, restricted activities, interests, play and repetitive actions
Autism Spectrum Disorders
Evidenced by: Impaired ability to make friends w/ peers, initiate or sustain a conversation w/ others, absence or impairment of imaginative and social play, repetitive/unusual use of language, restricted patterns of interest w/abnormal intensity, preoccupation w/ certain objects or subjects, inflexible adherence to routines or rituals, repetitive motor behavior
Epidemiology:
Rise in prevalence, 1 in 88, 3-‐4x higher in boys
Etiology:
Neurobiologic disorder, gene/environment interaction, advanced parental age, immune system dysfunction
Presentation:
Language delay, behavior problems, delayed
and disordered communication, atypical social interactions,
restricted range of interests, deficits in joint attention, social referencing, theory of mind
Screening:
At well child visits-‐ surveillance (elicit parent concerns), screening (at 9,18,30 mo), screening for autism at 19 and 30 months; Use M-‐CHAT from 18 mo to 4 years; detects ASD, language impairments, MR
Diagnosis:
Qualitative impairment in social interaction,communication, restricted repetitive and stereotyped patterns of behavior
Associated medical conditions:
Fragile X syndrome, tuberous sclerosis, down syndrome, William syndrome, turner syndrome, NF, metabolic disorders, landau kleffner syndrome
Most commonly diagnosed neurobehavioral disorder in childhood:
Attention Deficit/Hyperactivity Disorder
Elements of Attention Deficit/Hyperactivity Disorder
- Hyperactivity
* Impulsiveness
Hyperactivity
fidgets, unable to stay seated, inappropriate running/climbing, difficulty in engaging in leisure activities quietly, on the go, talks excessively
Impulsiveness
blurts out answer before question is finished, difficulty awaiting turn, interrupts or intrudes on others
Inattentiveness
to details, careless mistakes, difficulty sustaining attention, seems not to listen, fails to finish tasks, difficulty organizing, avoids tasks requiring sustained attention, loses things, easily distracted, forgetful
Attention Deficit/Hyperactivity Disorder in Children 6-‐12 yo:
Easily distracted, errors in homework, poorly organized or incomplete, disruptive in class, out of seat, unwilling/unable to complete chores at home, fails to wait turn in games
Attention Deficit/Hyperactivity Disorder in Adolescents 13-‐18:
Hyperactivity less visible, displays inner restlessness, disorganized schoolwork, difficulty working independently, difficulty interacting w/ peers
Attention Deficit/Hyperactivity Disorder in Adults:
Problems w/inattention and concentration, failure to plan ahead, disorganization, difficulty initiating and completing projects, premature shifting of activities, time management, forgetfulness, impulse decisions
Attention Deficit/Hyperactivity Disorder Pathophysiology:
Dopamine and Norepi have best documented roles in attention, concentration and cognitive function.
Attention Deficit/Hyperactivity Disorder Treatment:
Education about disorder, medication, behavioral therapy, environmental support
