Development Flashcards
Medical/Biological Neonatal Risk Criteria for Developmental Delay
7
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)
MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 2
(5)
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)
MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY (3)
(6)
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).
MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 4
(6)
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)
Other Risk Criteria to make a referral***
8
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.
Freud Oral – Birth to 18 months
3
Mouth is primary body zone
Sucking and eating
Major conflict weaning
Interpersonal focus on self with little differentiation from others
Freud Anal – 18 months to 3 years
4
- Anus is primary body zone
- Major conflict: toileting
- Major activities toilet training
- Interpersonal focus is rebellion vs. compliance with parents wishes
Freud Phallic – 3-6 years
4
- 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
Freud – Latency 6-11 years
4
- No primary body zone
- Social relationships are very important** mastery over impulses
- No major conflict
- Identification with same sex peers and powerful heroes
Freud: 11-18 years
Genital (4)
Primary body zone: genital
Sexual maturity and expression are major activities
Separation from family is the major conflict
Interpersonal focus: Successful extrafamilial relationships
Erickson
Trust vs. Mistrust (4)
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
Erikson
Autonomy vs. Shame (3)
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
Erikson
Initiative vs. Guilt (4)
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
Erikson
Industry vs. Inferiority (4)
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
Erikson - Identify vs. Role confusion (3)
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
Controversies around Erikson
Very influential theorist of emotional development
Developmental challenges as points in which the individual must choose the more desirable emotional stance
Noam
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
Stella Chess
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%)
Alexander Thomas and Stella Chess
Easy
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
Alexander Thomas and Stella Chess
Difficult
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
Alexander Thomas and Stella Chess
Slow to warm up
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
Alexander Thomas and Stella Chess
Goodness of Fit
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”
Stages of Cognitive Development - Jean Piaget (First 2)
- Sensorimotor Stage:
Birth to 2 years old
• No thinking structures - Preoperational Stage:
2-7 years old
• Develop language skills cognitive structures – prelogical
Stages of Cognitive Development - Jean Piaget (Second 2)
3. Concrete Operational Stage: 7 years to Adolescence – • Begins to question life. • Solves problems but haphazardly • Mass, number, linear time • Deductive reasoning
- Formal Operations Stage:
Adolescence and onward –
• capable of sophisticated logical thought.
• Can think both abstract and hypothetically
• Solves problems using the logic of combinations
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
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
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
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.
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
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
Developmental Screening
Access a child’s current developmental function compared with a standardized sample of children of same age
Purpose of Developmental Screening
Identify those children with delays
Do not identify children without delays
Too time consuming to perform at each visit
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)
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
Moro
Age of emergence
Age of disappearance
Complete at 37 weeks
4 months
Tonic Neck
Age of emergence
Age of disappearance
35 weeks, peaks at 4-6 weeks of life
4-6 months
Palmar grasp
Age of emergence
Age of disappearance
28 weeks
3-6 months
Placing, stepping
Age of emergence
Age of disappearance
37 weeks
6-8 weeks
Ankle clonus, up to 5-10 beats
Age of emergence
Age of disappearance
33-35 weeks
1 month
Pupillary response
Age of emergence
Age of disappearance
32 weeks
Never
Babinski
Age of disappearance = + until start to walk
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
Fontanel
Posterior fontanel: 2 months
Anterior fontanel: 18months - 2 year
Birth weight
Birth weight to 6 months: one ounce a day
6-12 months: 1⁄2 ounce per day
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
4 weeks (4)
Lifts and turns head
Raise head momentarily to ventral
Reflex grasp
Follows with eyes to midline
5 weeks (4)
Regards Face
Lifts head while prone
Equal movements of extremities
Mother responds to infant cues
2 months (5)
Follows to midline Sustain head in ventral Active grasp Vowel sounds--coos Smiles responsively
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
Red Flags at 3 months (3)
No social smile
Persistent fisting
Failure to alert to visual/auditory stimuli
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
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Language
3 months to 6 months
Receptive:
Works to localize vocalization sound Enjoys toys that make noise
Responds to name at 6 month
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
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
Language
12 to 15 months
Receptive
Follow one step direction
Expressive
Shakes head Use of 3-6 words
Language
15-18 months
Receptive
Points to objects/picture 18 months
Expressive
Repeats words Says no
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
Language
24-30 months
Receptive
2 step directions
Able to point to different actions
Expressive
Less jargon
Simple questions
Joins in songs
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
Language
36-48 months
Points to objects by category
5 to 6 word sentences by age 4
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!
Recommendations
- Screening tool
- Formal observation
- Use Caution - Parent interview
- Don’t ask for recall
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!
Where to Refer
Audiologist/ENT for hearing related issues
Early Intervention (children 3 yr.)
American Speech Language and Hearing Association 1-800- 498- 2071
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
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
PLAY
Solitary play: infancy
Parallel play: toddler
Preschooler:
Cooperative play
Dramatic presented play
Rough and tumble play
