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
