Development Flashcards

1
Q

Medical/Biological Neonatal Risk Criteria for Developmental Delay
7

A

Birth weight less than 1501 grams
Gestational age less than 35 weeks
Central nervous system insult or abnormality (including neonatal seizures intracranial hemorrhage, need for ventilator support for more than 48 hours, birth trauma)
Congenital malformations
Asphyxia (Apgar score of three or less at five minutes)
Abnormalities in muscle tone, such as hyper- or hypotonicity
Hyperbilirubinemia (> 20 mg/dl)

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2
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 2
(5)

A

Hypoglycemia (serum glucose under 20
mg/dl)

Growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem)

Presence of Inborn Metabolic Disorder (IMD)

Perinatally- or Congenitally transmitted infection (e.g., HIV, hepatitis B, syphilis)

10 or more days hospitalization in a Neonatal Intensive Care Unit (NICU)

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3
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY (3)
(6)

A

Maternal prenatal alcohol abuse
 Maternal prenatal abuse of illicit substances
 Prenatal exposure to therapeutic drugs with known potential development implications (e.g., psychotropic medications, anticonvulsant, antineoplastic)
 Maternal PKU
 Suspected hearing impairment (e.g., familial history of hearing impairment or loss; suspicion based on gross screening measures)
 Suspected vision impairment (suspicion based on gross screening measures).

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4
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 4
(6)

A

 Parental or caregiver concern about developmental status
 Suspect score on standardized developmental or sensory screening test
 Serious illness or traumatic injury with implications
for central nervous system development and requiring hospitalization in a pediatric intensive care unit for ten or more days
 Elevated venous blood lead levels (above 19 mcg/dl)
 Growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia)
 Chronicity of serous otitis media (continuous for a minimum of three months)

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5
Q

Other Risk Criteria to make a referral***

8

A

 No prenatal care
 Parental developmental disability or diagnosed serious and persistent mental illness
 Parental substance abuse, including alcohol or illicit drug abuse
 No well child care by 6 months of age; or significant delay in immunizations; and/or,

History of child abuse or neglect;
Concern re: parenting due to poor bonding;
Impairment in psychological/interpersonal functioning
Homelessness or dislocated housing status.

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6
Q

Freud Oral – Birth to 18 months

3

A

Mouth is primary body zone
Sucking and eating
Major conflict weaning
Interpersonal focus on self with little differentiation from others

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7
Q

Freud Anal – 18 months to 3 years

4

A
  • Anus is primary body zone
  • Major conflict: toileting
  • Major activities toilet training
  • Interpersonal focus is rebellion vs. compliance with parents wishes
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8
Q

Freud Phallic – 3-6 years

4

A
  • Genital area is primary body zone
  • Genital exploration and fantasy are major activities

• Major conflict = Oedipal complex
((psychoanalytic theory, a desire for sexual involvement with the parent of the opposite sex and a concomitant sense of rivalry with the parent of the same sex))

• Attraction to opposite sex parent and Identification with same sex parents as major interpersonal focus

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9
Q

Freud – Latency 6-11 years

4

A
  • No primary body zone
  • Social relationships are very important** mastery over impulses
  • No major conflict
  • Identification with same sex peers and powerful heroes
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10
Q

Freud: 11-18 years

Genital (4)

A

Primary body zone: genital

Sexual maturity and expression are major activities

Separation from family is the major conflict

Interpersonal focus: Successful extrafamilial relationships

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11
Q

Erickson

Trust vs. Mistrust (4)

A

Infancy

Develops when needs are met by a consistent loving person

Mistrust develops when needs are not consistently met

With trust, Sense of hope and optimism is outcome

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12
Q

Erikson

Autonomy vs. Shame (3)

A

Toddler

Child gains control of body and wants to use power to control environment

Shame and doubt appear when child is forced to be dependent when the child can actually master control

Positive outcome = sense of self control and will-power

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13
Q

Erikson

Initiative vs. Guilt (4)

A

3-5 years preschool

Child uses his/her senses and power to explore physical world and imagine a fantasy world

Conscience is acquired as child starts to listen to an inner voice

Guilt arises when child does something in conflict with goals of other

Positive outcome is direction and purpose

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14
Q

Erikson

Industry vs. Inferiority (4)

A

School Age

Child start to complete activities and tasks and achieving a sense of accomplishment and mastery

Rule learner and works cooperatively and competitively with others

Inferiority comes when more is expected than the child can achieve

Sense of competence is the positive outcome

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15
Q

Erikson - Identify vs. Role confusion (3)

A

Adolescent**

Preoccupied with physical appearance, how he or she is seen by others, role he/she plays and how his/her concepts and values mesh with those of peers and society

Unable to solve conflicts between concept of self and society

Positive outcome is a sense of fidelity to values and other people

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16
Q

Controversies around Erikson

A

Very influential theorist of emotional development

Developmental challenges as points in which the individual must choose the more desirable emotional stance

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17
Q

Noam

A

Feels early adolescence is more concerned about group cohesion and less concerned about identify

Younger adolescent are more susceptible to peer pressure

Development is not linear

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18
Q

Stella Chess

A

 Easy (40%)
Regular routines, cheerful

 Difficult (10%)
Irregular, slow to accept change  Negative responder

Slow to warm (15%)
Inactive, mild low key  Slow adjustment

 Mixed (35%)

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19
Q

Alexander Thomas and Stella Chess

Easy

A

 Temperament is innate

 Easy: 40% of children
• Regularity
• Positive approach
• High adaptability
• Mildly to moderately intense mood
Sleep through the night, coo etc.
  • Parent needs to spend separate time with child since he can be forgotten
  • May do what other’s wants even though no in best interest
  • Child is trusting
  • Teach child how to develop own rules
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20
Q

Alexander Thomas and Stella Chess

Difficult

A
 Difficult: 10% of children
Irregularity of biological functioning
Negative withdrawal in response to new stimuli, non adaptability
Slow adaptability
Intense mood

Parent needs to be
- Firm and consistent
- Patient
- Gradual repeated reinforcement of positive and
negative for expected
- Give minimum number of rules for any one time
- Provide venue to extra emotions and energy

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21
Q

Alexander Thomas and Stella Chess

Slow to warm up

A
 Slow to warm up: 
15% of children: 
- negative mood of mild intensity
- Slow adaptability to new situations
- Parent need to maintain calm as anger accelerates for child’s reaction
- Do not compete with child
- Repetition is needed
- Maintain consistent rules
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22
Q

Alexander Thomas and Stella Chess

Goodness of Fit

A

 Goodness of Fit

Central is understanding how child’s temperament on
the family

Impact of temperament on child’s adaptive functioning

Child’s temperament fits with parental goals, standards, and values that affects the nature of the parent’s responses to the child.

Difference between there are differences between parental expectation and the child’s temperament “poor fit”

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23
Q

Stages of Cognitive Development - Jean Piaget (First 2)

A
  1. Sensorimotor Stage:
    Birth to 2 years old
    • No thinking structures
  2. Preoperational Stage:
    2-7 years old
    • Develop language skills cognitive structures – prelogical
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24
Q

Stages of Cognitive Development - Jean Piaget (Second 2)

A
3. Concrete Operational Stage:
7 years to Adolescence –
• Begins to question life.
• Solves problems but haphazardly
• Mass, number, linear time
• Deductive reasoning
  1. Formal Operations Stage:
    Adolescence and onward –
    • capable of sophisticated logical thought.
    • Can think both abstract and hypothetically
    • Solves problems using the logic of combinations
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Kohlberg Birth to 18 months 18 Months to 9 years Two Orientations**
Birth to l8 months “Amoral” Moral reasoning cannot begin until the child reaches a certain level of cognitive development 18 months to 9 years Preconventional: Obedience and punishment orientation* • Behavioral decision made on fear of punishment • Good and bad defined in terms of physical consequences Instrumental Relativist Orientation (3-6 years)* Behavioral decisions made based on concern of self and egocentric satisfaction although occasionally will do something to please another if adv. for self
26
Kohlberg Conventional Thinking two orientations**
Most people remain here Interpersonal concordance • Moral thinking is guided by individual’s interpersonal relationships and place in society • Behavioral decision made on what child desires • Desires to gain approval of significant others Law and order orientation • Behavioral decision based on laws and respect for authority
27
Kohlberg | Post-Conventional
Social Contract Legalistic • Makes decisions based on personal beliefs and values • Adolescent Universal Ethical Principle • Decisions made based on higher principle • Young adult
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Key Principles (7) -- 1
Growth and development is orderly and sequential Each child sets their own pace Growth is cephalocaudal Growth is Proximodistal Behaviors become increasing integrated There are critical periods in development Environmental, social, genetics, nutrition all play a role.
29
Key Principles (6) -- 2
Responses to stimuli go from generalized reflexes involving the entire body to discrete voluntary actions Growth milestones are predictable Language delays are the most common Speech and language are not synonymous Receptive and expressive language are different Skills are built on each other and are rarely skipped
30
Developmental Surveillance
Monitoring a child’s development over time  Ongoing process of accessing a child’s developmental status at each well child visit  Taking a thorough history  Reviewing developmental milestones  Making skilled observations of the child during the office visit  Eliciting parental concerns Observes the child’s rate of  Development  Temperament style  Emotional adjustment
31
Developmental Screening
Access a child’s current developmental function compared with a standardized sample of children of same age
32
Purpose of Developmental Screening
Identify those children with delays Do not identify children without delays Too time consuming to perform at each visit
33
Developmental Screening Tools
 Child development inventories Minnesota Child Development Inventories Ages and Stages Questionnaire (formerly infant monitoring system) Parent’s Evaluations of Developmental Status (PEDS)
34
Newborn Reflexes Tonic Neck Stepping and Walking
Tonic neck Increased tone Leg extension of side of head direction Flexion in contralateral arm and leg Stepping and walking Range from minimal weight bearing to several brisk steps with plantar stimulation
35
Moro Age of emergence Age of disappearance
Complete at 37 weeks 4 months
36
Tonic Neck Age of emergence Age of disappearance
35 weeks, peaks at 4-6 weeks of life 4-6 months
37
Palmar grasp Age of emergence Age of disappearance
28 weeks 3-6 months
38
Placing, stepping Age of emergence Age of disappearance
37 weeks 6-8 weeks
39
Ankle clonus, up to 5-10 beats Age of emergence Age of disappearance
33-35 weeks 1 month
40
Pupillary response Age of emergence Age of disappearance
32 weeks Never
41
Babinski
Age of disappearance = + until start to walk
42
Physical Growth Head circumference
Length 9-11 inches first year Head circumference 2 cm/month to 3 months 1 cm/month 4-6 months .5 cm/month 6-12 month
43
Fontanel
Posterior fontanel: 2 months | Anterior fontanel: 18months - 2 year
44
Birth weight
Birth weight to 6 months: one ounce a day | 6-12 months: 1⁄2 ounce per day
45
Physical Growth Birth weight by end of second year Length
Birth weight quadrupled by end of 2nd year 2-9/ 5 pounds per year ``` Length: • 5 inches in 2nd year • 3-4 inches in 3rd year • 2-3 inches per year post this 20 teeth by 2.5 years ```
46
4 weeks (4)
Lifts and turns head Raise head momentarily to ventral Reflex grasp Follows with eyes to midline
47
5 weeks (4)
Regards Face Lifts head while prone Equal movements of extremities Mother responds to infant cues
48
2 months (5)
``` Follows to midline Sustain head in ventral Active grasp Vowel sounds--coos Smiles responsively ```
49
3 months (6)
Raise head above ventral plane + legs extended-up to 90 degree angle Will make hand contact and hold briefly Some head control Grabs rattle Follows past midline Stop movement, appears to listen, turn toward sound
50
Red Flags at 3 months (3)
No social smile Persistent fisting Failure to alert to visual/auditory stimuli
51
4 months (7)
No head lag Hands in midline Bring objects to mouth May have bald spot on occiput due to midline position Loud laugh May go from laughing to crying Follows past midline hold head to 90 degrees
52
5 months (3)
Head erect and steady Begin to roll over: first from prone to supine Can be pulled to a standing position and can support wt.
53
6 months (10)
``` No head lag Reach for an object Turns to voice Transfer hand to hand after learning grasp Flex knees temporarily then extend May sit alone, but can roll especially from prone position Bears some weight Clear preference for caregiver May accept strangers; cuddles Interested in legs and feet ```
54
7 months (3)
Pursue a pellet with raking -cannot pick up Will respond to changes in facial expressions Pivot in prone position to go after an object
55
8 months (7)
Go to sitting position without help with back straight Stand if hands are held Repetitive constants: ma-ma, baba Respond to name Separation anxiety Play peek-a-boo in preparation Feeds self crackers Turns to voice
56
9 months (10)
``` Sits without support, stands holding on Imitates speech sounds Creep or crawl May take steps with both hands held Poke with index finger Pincer motion (thumb finger grasp) Wave bye-bye Release an object by request Object permanence Become less dependent on presence of mother ```
57
Red flags between 6-12 (4)
Persistence of primitive reflexes after 6 months No babbling by 6 month No reciprocal vocalization by 9 months Inability to localize sound by 10 months
58
12 months | 7
TODDLER—Autonomy-vs.-Shame: doubt 12 months Responds to no Stand alone for 2 seconds Rise independently and take step Pincer without ulnar Games with ball Extend an object and release it into offered hand May show by behavior knowledge of objects
59
15 months (8)
Walks alone Stoops to recover toy on floor Says 1 word besides "Dada" and "Ma-ma" Jargon Follows 1 step command, no gesture Put pellet into a small bottle Put 1 cube on top of another with demonstration Manages cup
60
18 months (10)
Says 3 words besides “Mama”, “Dada” Walks backwards Imitates household chores e.g. sweeping Up stairs one at a time with 1 hand held 20 months: go down stairs one at a time with 1 hand held Scribbles Dump pellet from bottle Stacks 2 blocks Lifts elbow
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2 years (13)
Gains 5-6 pounds and 5 inches Head growth is 2cm Kicks ball forward Removes article of clothing (not hat) Combines two words Mild lordosis with protuberant abdomen 8 more teeth to total 14-16 Run about stage Tower of 7 cubes Imitate circular strokes horizontal line Empty trash cans and drawers Parallel play Speech should be understood
62
Red Flags -- 2 years (6)
``` No consonant production by 15 months No words Hand dominance before 18 months Not walking by 18 months Inability to walk up and down stairs by 24 months No two word sentences by 24 months ```
63
Red Flags in Evaluating Infant Motor Development | Motor
Motor Abnormal movement patterns • Increased tone: Spasticity • Early rolling (1 month) • Pulling directly to stand @ 4 months • W-sitting • Persistent toe walking • Hand dominance prior to 18 months • hemiparesis
64
Red Flags in Evaluating Infant Motor Development | Motor Development
``` Motor Development No rolling to prone to supine by 7 months No rolling supine to prone by 9 months No unsupported sitting by 10 months No independent steps by l8 months ```
65
Important Fine Motor Milestones
``` Tower of 8 cubes: 2.5 years Thumb wiggle 2.5 years Copies circle: 3-3.5 years Person with 6 parts 4.5 years Copies square by 5 years but can start as early as 4.5 years ```
66
Gender Identity
2 year old: Knows male or female 3-4 year Show sex typed preference 5-6 year old Notion of how male or female should dress
67
Language Overview
Language is a sequential acquisition in following pattern: Emergence of words and basic vocabulary Transition from one word to word & phrase combinations Transition from single to complex sentences Most importantly, language acquisition is influenced by biological factors as well as child’s rearing environment
68
How Language Develops Receptive vocab vs. Spoken vocab
Baby’s earliest communication is to attract attention from parents & others in environment Receptive Vocabulary refers to words an individual understands & which greatly increases in second year Spoken Vocabulary begins when infant utters its first word occurring at approximately 10 to 15 months of age
69
Language | Birth to 3 months
Receptive: Attends to voices/sounds Prefers parental voice may orient to voice by turning eye Expressive: Has different cries Vocalizes (coos, gurgles) Reciprocal vocalization
70
Language | 3 months to 6 months
Receptive: Works to localize vocalization sound Enjoys toys that make noise Responds to name at 6 month
71
6-9 months
Receptive Looks to family member when named Begins to understand words Expressive Vocal play Babbles with a string of syllables with intonation. Uses mama and dada nonspecific
72
Language 9 months-1 year
Receptive Understands verbal cues peek a boo Looks when name is called 70 words-12 months Expressive Uses mama and dada specific Imitates Waves bye bye Reaches to be picked up
73
Language | 12 to 15 months
Receptive Follow one step direction Expressive Shakes head Use of 3-6 words
74
Language | 15-18 months
Receptive Points to objects/picture 18 months Expressive Repeats words Says no
75
Language | 18-24 months
Receptive Follows two step directions Enjoys simple stories Expressive Language explosion Up to 50 words with average of 200 words by age 2 years 50% intelligible
76
Language | 24-30 months
Receptive 2 step directions Able to point to different actions Expressive Less jargon Simple questions Joins in songs
77
Language | 30 to 36 months
Receptive 2-3 step directions Identifies colors Expressive Uses 900 to 1000 words Speech is 75% intelligible by age 3 years
78
Language | 36-48 months
Points to objects by category 5 to 6 word sentences by age 4
79
Be Suspicious
Developmental language disorders are not rare--> affect between 5-8% of all preschoolers. Language disorders are so potentially disruptive and handicapping Must be alert to the possibility in every child If you suspect a speech/language delay or comprehension difficulty, obtain a hearing test immediately!
80
Recommendations
1. Screening tool 2. Formal observation - Use Caution 3. Parent interview - Don’t ask for recall
81
When to Refer
``` When recommended by screening tool Delay in language development > 1 year Speech noticeably unintelligible Positive hearing loss Presence of an obvious medical problem NOTE: Referral to evaluation and intervention programs (Early Intervention Program) are mandated by law! ```
82
Where to Refer
Audiologist/ENT for hearing related issues Early Intervention (children 3 yr.) American Speech Language and Hearing Association 1-800- 498- 2071
83
Other Language Concerns
``` Stuttering (repetition/pauses/eye blink) Preschooler (2-5 yrs.) normal Refer • If the child > 6yrs • Embarrassed • Interferes with communication • Parents very concerned • Lasts > 6mo ```
84
Anticipatory Guidance
Listen Show enthusiasm for your child’s interests Discuss activities while in progress Use recasting methods Speak slowly and clearly Teach parent to avoid baby talk and to read at least once a day Avoid correcting child’s language Introduce your child to other adults and children
85
PLAY
Solitary play: infancy Parallel play: toddler Preschooler: Cooperative play Dramatic presented play Rough and tumble play