Developmental Milestones & Periods of Development

Question 1

Gestation & Birth

Answer 1

Gestation refers to the developmental period of the fetus, or unborn child, in the mother’s uterus.
This period begins with conception and ends with birth. Gestation typically lasts 40 weeks.

Question 2

Infancy

Answer 2

Infancy is the period from birth through approximately 18 months of age. It is characterized by
significant physical and emotional growth.

They develop sensory and motor skills, and by
18 months of age they are walking, talking, and performing simple self-care tasks such as eating
with a spoon, drinking from a cup, and undressing

Question 3

Early Childhood

Answer 3

Toddlers and preschool children represent the period of early childhood, which begins at 18 months
of age and lasts through age 5 years.
During the early childhood period, children become
increasingly independent and establish more of a sense of individuality.

Question 4

Middle Childhood

Answer 4

Ten-year-old Phillip is very concerned about being accepted by his peer group. He insists on
wearing the same tennis shoes as the other boys. He and his friends spend hours playing seemingly
endless baseball games. They follow the rules but do not really keep scores.

Question 5

Adolescence

Answer 5

Fifteen-year-old Phillip wants to get a job in the music store at the mall. He thinks he would be
good at the job because of his extensive knowledge of popular bands and musicians. An additional
benefit is that all his friends hang out at the mall.

Question 6

Normal

Answer 6

Defined as that
which occurs habitually or naturally
In this chapter, normal is used interchangeably with typical

Question 7

Development

Answer 7

Is the act or process of maturing or acquiring skills

ranging from simple to more complex

Question 8

Growth

Answer 8

Is the act or process of maturing or acquiring skills

ranging from simple to more complex

Question 9

Typical Development

Answer 9

t is defined as the natural process of acquiring skills ranging from simple to
complex.

Question 10

Cultural Context

Answer 10

Customs, beliefs/values, standards, and expectations

Question 11

Personal Context

Answer 11

Features of the person such as age, gender, socioeconomic status, and level of education

Question 12

Physical Context

Answer 12

Nonhuman aspects of the environment

Question 13

Social Context

Answer 13

Significant others and the larger social group

Question 14

Temporal Context

Answer 14

Stage of life, time of day, and time of year

Question 15

Virtual Context

Answer 15

Computer or airways, simulators, chatrooms, and radio

Question 16

Periods of Development

Answer 16

t are intervals of time during which a child increases in size and acquires
specific skills.
Pediatric OT practitioners work with children of varying chronologic ages. The
following normal developmental periods are used as the basis for comparison in subsequent
chapters dealing with normal development

Question 17

General Principals of Development

Answer 17

Development is sequential and predictable.
• Maturation and experience affect development.
• Development involves changes in the biologic, psychological, and social systems.
• Development occurs in two directions: horizontal and vertical.
• Development progresses in order in three basic sequences.
1. Cephalad to caudal
2. Proximal to distal
3. Gross to fine

Question 18

Performance skills

Answer 18

Performance skills are observable actions. Because they are observable actions and many performance skills are required to complete an occupation, the OT
practitioner may target performance skills during intervention. Performance skills are categorized
into motor, process, and social interaction skills.

Question 19

Motor Skills

Answer 19

Motor skills are observable actions observed as the child interacts and moves objects and self in the
environment. Motor skills involve gross and fine motor actions, including the following: aligns,
stabilizes, positions, reaches, bends, grips, manipulates, coordinates, moves, lifts, walks, transports, calibrates, flows (uses smooth and coordinated movements), endures, and paces.
This list is not all inclusive. OT practitioners prioritize key performance skills to address during intervention.
For example, a child playing on the playground may use the following motor performance skills:
• Stabilizes his body to move.
• Walks toward a variety of equipment, or runs to play a game.
• Endures 1 hour of physical activity outside.
• Coordinates both sides of his body to pump swing.
• Grips the ropes on the swing.
• Bends to tie his shoes.

Question 20

Process Skills

Answer 20

Children plan, make decisions, and problem solve during everyday occupations. They use these
cognitive process skills to adjust and adapt to changes in the environment, physical self, or social
situations while engaging in ADLs, IADLs, play (leisure), education, or work. The observable
actions that constitute process skills include the following: paces, attends, heeds, chooses, uses,
handles, inquires, initiates, continues, sequences, terminates, searches/locates, gathers, organizes,
restores, navigates, notices/responds, adjusts, accommodates, and benefits.
For example, a child on the playground playing a game of tag engages in the following process
skills:
• Paces himself so he can complete the entire game.
• Chooses who he wants to run after to tag.
• Initiates play with his peers.
• Continues to run when not tagged.
• Terminates the activity (running) when he is tagged.
• Searches for other friends in the game.
• Adjusts his activity by going to a new location.
• Navigates his body around obstacles and peers.
• Benefits (prevents problems) by slowing down to get tagged.

Question 21

Social Interaction skills

Answer 21

Social interaction skills refer to those actions involved with engaging in activities with another
person. Communication and language skills are considered part of social interaction skills. Social
interaction skills include the following observable actions: approaches/starts, concludes/disengages,
produces speech, gesticulates (uses socially appropriate gestures), speaks fluently, turns toward,
looks, places self, touches, regulates, questions, replies, discloses, expresses emotion, disagrees,
thanks, transitions, times response, times duration, matches language, clarifies, acknowledges and
encourages, empathizes, heeds, accommodates, and benefits.
Children develop and use social interaction skills to engage in a variety of occupations. For
example, a child in the classroom may use social interaction skills in the following ways:
• Approaches the teacher in the morning to say hello.
• Concludes discussion with peer when class starts.
• Produces speech to answer a question in front of class.
• Turns to the child speaking when he hears his name.
• Looks at classmate (social partner) when engaged in conversation.
• Regulates responses to teacher’s questions.
• Disagrees with classmate in appropriate manner.
• Clarifies homework assignment.
• Thanks teacher for helping him.
• Transitions to and from recess without becoming upset.

Question 22

Activities of Daily Living

Answer 22

• Bathing and showering
• Bowel and bladder management
• Toilet hygiene
• Dressing
• Eating
• Feeding
• Functional mobility
• Personal device care
• Personal hygiene and grooming
• Sexual activity

Question 23

Development of Coordinated Movement in Infancy

Answer 23

Extension → Flexion → Lateral Flexion → Rotation
Primitive Reflexes: Primitive reflexes are automatic movements that are usually stimulated by sensory factors and performed without conscious volition.
Righting Reactions: Righting reactions are postural responses to changes of head and body positions.
Equilibrium Reactions: Equilibrium reactions are automatic, compensatory movements of the body parts that are used to maintain the center of gravity over the base of support when either the center of gravity or the supporting surface is displaced.
Protective Extension Responses: Protective extension responses are postural reactions that are used to stop a fall or to prevent injury when equilibrium reactions fail to do so.

Question 24

Piaget’s Stages of Cognitive Development

Answer 24

Sensorimotor (birth to 2 years)- Knows about environment through movement and sensations.

Preoperational (2 to 7 years)- Begins to think symbolically and uses words or pictures to represent objects. Tends to be egocentric.

Concrete operational (7 to 11 years)- Begins to think logically about concrete events and problems.

Formal operations (11+ years)- Begins to think abstractly. Reasons about hypothetical problems.

Question 25

Instrumental Activities of Daily Living (IADL)

Answer 25

• Care of others
• Care of pets
• Child rearing
• Communication management
• Community mobility
• Financial management
• Health management and maintenance
• Home establishment and management
• Meal preparation and cleanup
• Religious observance
• Safety and emergency maintenance
• Shopping

Question 26

Laws

Answer 26

All adolescents from the ages of 3 to 21 with special needs are eligible for OT services under the 1975 Public Law 94-142, Education of All Handicapped Children’s Act; Part B.

Under the 1997 Public Law 105-17, Individuals with Disabilities Education Act (IDEA), every adolescent receiving special education services when he or she reaches age 14 requires an individualized transition plan in his or her IEP; by age 16, it should include a statement of the needed transition services,
objectives, and activities.

Furthermore, an amendment to the IDEA (PL105-17) expanded the scope of alternative education programs for at-risk students to include all those with disabilities and behavioral issues that need be addressed outside the mainstream educational system. The 2004
Individuals with Disabilities Improvement Education Act sought to ensure that schools and parents have the resources they need to promote academic achievements and life skills in students with disabilities.

No child left behind act

Question 27

OT Role

Answer 27

The occupational therapist is responsible for the selection of assessments used during evaluation, interpretation of results, and development of the intervention plan.

Question 28

OTA Role

Answer 28

The OTA may gather evaluative data under the supervision of the occupational therapist using an approved structured format but is not responsible for the interpretation of assessment results; he or she may
contribute to the process by sharing knowledge of the client gained during the assessment process.

Question 29

MOHO

Answer 29

Volition
Habituation or routines
Performance
Environment

Question 30

Person–Environment–Occupational-Performance (PEOP)

Answer 30

Child
Environment
Occupational performance

Question 31

MOPs

Answer 31

MOPs provide practitioners with a framework for thinking about and arranging their materials.
They help practitioners focus on factors that influence functioning. MOPs are developed from OT
theory and philosophy

Question 32

Canadian Occupational Performance Model

Answer 32

Spirituality
Occupation
Context

Question 33

Frame Of Reference

Answer 33

FORs are used to direct occupational therapy intervention.
Developmental
Biomechanical
Sensory Integration
Motor Control
Neurodevelopmental
Model Of Human Occupation
Rehabilitaiton

Question 34

Therapeutic Use of Self

Answer 34

Therapeutic use of self is the OT practitioner’s ability to communicate with the child and the child’s
family or caregivers while being aware of his or her own personal feelings.

Question 35

Specialty clinics OTA can work in

Answer 35

• Patients who have had an acute rehabilitation in-patient stay;
• NICU baby follow-up clinic/high-risk infant clinic
• Hypertonicity clinic
• Spinal bifida clinic
• Rheumatology clinic
• Cystic fibrosis clinic
• Neuro-oncology clinic
• Cleft palate clinic

Question 36

AOTA Code of Ethics

Answer 36

1. Beneficence
2. Nonmaleficence
3. Autonomy and confidentiality
4. Social justice
5. Procedural justice
6. Veracity
7. Fidelity

Question 37

OT Settings

Answer 37

1. NICU
2. Step-down nursery or the PICU
3. Acute care
4. Subacute
5. Residential or long-term care
6. Home care
7. School

Question 38

Rights of Parents and Children

Answer 38

The IDEA-R outlines several procedural safeguards for children with disabilities and for their
parents. These procedures are detailed in the U.S. Code of Federal Regulations, Title 34, Subtitle B,
Chapter III, Part 300. The safeguards include notifying parents in writing of all proposed actions (prior written notice), obtaining written consent to evaluate/reevaluate and allowing parents to attend IEP team meetings. Additional procedural safeguards include the right to request an independent evaluation and the right to appeal school decisions through mediation. Mediation is a voluntary process in which an impartial officer helps schools and families reach an
agreement without going through a due process hearing. The IDEA-R requires that school districts
inform parents of their rights in a written format.

Question 39

Acquired Musculoskeletal Disorders

Answer 39

Acquired musculoskeletal disorders are conditions that are not present at birth and involve injury or trauma to the skeletal and/or muscular systems. Soft tissue injuries and fractures require the attention of an orthopedist, a medical doctor who specializes in diseases of the musculoskeletal system.

Question 40

Amputation

Answer 40

An infant born missing all or part of a limb has a congenital amputation. A traumatic amputation is
the result of an accident, infection, or cancer. Each year, approximately 26 of 10,000 children in the
United States are born missing all or part of a limb.

Question 41

Arthrogryposis

Answer 41

Arthrogryposis is sometimes genetic but is also attributed to reduced amniotic fluid during
gestation or central nervous system (CNS) malformations. Arthrogryposis can range from mild
to severe, depending on the number of joints involved and the amount of muscle tissue missing. In the classic form of arthrogryposis, all the joints of the extremities are stiff, but the spine is not affected. In addition to contractures, muscles are often thin, weak, or missing. Arm posture with children with arthrogryposis often includes internal rotation, elbow extension with limited flexion, and flexed wrists with ulnar deviation. Contractures in the lower extremities are noted with typical posture including hip abduction and external rotation, knee extension or knee flexion contractures,
and foot deformities. Arm and leg muscles are small, with webbed skin covering some or all of the
joints. Infants are born with significant contractures that improve with aggressive ROM exercises
during infancy. In typical cases, all the joints of the arms and legs are fixed in one position, partly
due to muscle imbalance or lack of muscle development during gestation

Question 42

Congenital Hip Dysplasia

Answer 42

Congenital hip dysplasia (or dislocation of the hip) may be caused by genetic or environmental factors. An infant may be genetically prone to instability of one or both of the hip joints, and stretching of an unstable hip or prolonged time in a position that makes the hip vulnerable may cause a dislocation.

Question 43

Juvenile Rheumatoid Arthritis

Answer 43

There are three types of juvenile rheumatoid arthritis (JRA): Still’s disease (20% of cases), pauciarticular arthritis (40% of cases), and polyarticular arthritis (40% of cases) Children with JRA experience exacerbations and remissions of symptoms. During exacerbations, or
flare-ups, symptoms worsen, and the joints become hot and painful; joint damage can occur. During
remissions, or pain-free periods, children with JRA may resume typical activities. Joint protection techniques and energy conservation techniques are encouraged at all times so that these strategies become a habit By the time they are adults, 75% of individuals with JRA have permanent remission. However, these children may have functional limitations due to contractures and deformities.

Question 44

Osteogenesis Imperfecta

Answer 44

Osteogenesis imperfecta (OI) is a genetic condition in which collagen fails to form and blocks the scaffolding of bone mineral on the collagen base. Healthy growing children lay down 7% more bone than they resorb, whereas children with OI form only 3% more bone than they resorb.Consequently, children are prone to fractures with typical handling and movement. They are at high risk for developing scoliosis during childhood. Children with OI also have secondary osteoporosis.

Question 45

Achondroplasia

Answer 45

Achondroplasia, or dwarfism, is a genetic condition in which cartilage does not ossify into bones, especially long bones of arms and legs. Typical physical features include a large protruding forehead and short, thick arms and legs on a relatively normal trunk. Children with achondroplasia often have elbow flexion contractures and short fingers affecting fine motor development and hand use.

Question 46

Duchenne Muscular Dystrophy

Answer 46

One of the more common types of muscular dystrophy (MD) is Duchenne muscular dystrophy (DMD), or pseudohypertrophic (which means “false overgrowth”) MD. In children with DMD, muscle lacks a protein called dystrophin and is replaced by fat and scar tissue. The buildup of fat and scar tissue can make the muscles especially those of the calves look unusually large. DMD is seen only in boys because it is an X-linked genetic disorder and boys have only one X chromosome. About 1 in 3300 boys develops the condition. Most children with DMD survive until their 20’s, and a few live into their 30s. The cause of death is usually cardiopulmonary system (heart and lung)
complications that lead to pneumonia.

Question 47

Genetic and Chromosomal Disorders: Signs and

Symptoms

Answer 47

• Developmental delays
• Microcephaly
• Impaired cognitive development
• Unusual or excessive eating habits or patterns
• Small body structure
• Congenital anomalies
• Facial features characteristic of syndrome
• Simian crease in hands (characteristic of Trisomy 21 syndrome)
• Failure to thrive

Question 48

Erb’s Palsy (Brachial Plexus Injury)

Answer 48

During birth, stretching or tearing of the peripheral nerves in the brachial plexus that supply the arm and shoulder can cause Erb’s palsy, injury to the upper fibers of the brachial plexus. Erb’s palsy occurs in about 2% of births

Question 49

Seizures

Answer 49

Seizures are defined as transient disturbances of brain function resulting from abnormal excitation of cortical neurons. The diagnosis of epilepsy is made if a child has at least two unprovoked seizures at least 24 hours apart.

Question 50

Spina Bifida

Answer 50

Spina bifida, a condition in which one or more of the vertebrae are not formed properly in part because of malformed spinal canal, is the most common type of congenital spinal abnormality. Spina bifida is a neural tube defect that occurs very early in pregnancy when the CNS starts to form. Spina bifida is classified into three types: occulta, meningocele, and myelomeningocele.

Question 51

Shaken Baby Syndrome

Answer 51

Infants who are violently shaken by adults sustain serious brain damage, which is referred to as shaken baby syndrome, also known as abusive head trauma (AHT). When an infant is shaken, it causes the brain to hit the inside of the skull so hard that it bruises the brain or causes bleeding and thus can be considered a traumatic brain injury.

Question 52

Traumatic Brain Injury

Answer 52

A traumatic brain injury (TBI) is a serious injury to the brain, also known as a closed head injury (CHI) or head injury (HI). TBI results from damage to the CNS as a result of forces coming in contact with the skull. Damage to the nerve tissue occurs both during and after the immediate trauma.

Question 53

Attention Deficit Hyperactivity Disorder

Answer 53

ADHD is a prevalent neurobehavioral disorder characterized by developmentally inappropriate
levels of inattention and distractibility and/or hyperactivity that impairs adaptive function at home,
at school, and in social settings. It occurs in boys three times more often than in girls. Children with ADHD have issues such as difficulty with attention, hyperactivity, distractibility, and impulsivity

Question 54

Signs of Autism

Answer 54

Infant
• Stiffens when picked up or does not physically conform to the adult’s body when held
• Does not calm when held; may prefer to lie in the crib
• Startles easily when touched or when the bed is bumped
• Hates baths, dressing, or diaper changing
• Has poor sucking ability or is hard to feed
• Has poor muscle tone; body feels floppy
• Does not have age-appropriate head control or age-appropriate ability to sit, crawl, or walk
Children
• Seems unaware of surroundings
• Does not make eye contact
• Has general learning problems
• Does not relate to others
• Only eats certain food textures
• Refuses to touch certain textures (e.g., mud and sand)
• Has sleep problems such as difficulty getting to sleep or staying asleep
• Hyperactivity
• Withdrawn, miserable, anxious, or afraid
• Displays repetitive behavior or speech patterns
• Fixates on one object or body part
• Compulsively touches smooth objects
• Shows fascination with lights
• Flaps arms when excited
• Frequently jumps, rocks, or spins self or objects
• Walks on tiptoes
• Giggles or screams for no apparent reason
• Eats strange substances (e.g., soil, paper, toothpaste, soap, rubber)

Question 55

Rett Syndrome

Answer 55

Rett syndrome is a progressive neurologic disorder that occurs only in girls. It is a genetic disorderwith mutation of the X chromosome. The infant or toddler seems to be developing normally until 6 to 18 months of age, at which time regression in all skills is observed. Microencephaly, seizures, abnormal muscle tone, intellectual disability, loss of purposeful hand use, and stereotypicalpatterns of behavior (especially hand
wringing) emerge. Adolescents with Rett syndrome are
generally nonambulatory and do not have functional hand use.

Question 56

Therapeutic Positioning

Answer 56

The goal of therapeutic positioning is to provide children with safe, efficient, and effective postures that enable participation in social, academic, family, and
self-care activities. For example, OT practitioners may provide a corner seat to help a child sit upright during story time at school.

Question 57

Therapeutic Handling

Answer 57

Therapeutic handling allows the OT practitioner to feel children’s responses to changes in postures and movements and to modify handling as necessary to assist children in successful motor responses. Therapeutic handling is used to facilitate normal
postural control and movements so that children are able to engage in meaningful and ageappropriate activities.

Question 58

Approaches to Intervention Planning and Implementation

Answer 58

AOTA describes five approaches or strategies that direct intervention planning and
implementation:
1. Create or promote
2. Establish or restore
3. Maintain
4. Modify
5. Prevent