Human Development (ch 5)- peds Flashcards
What is normal gestational period?
38-42 weeks
Conceptual age =
age of a fetus or newborn in weeks since conception
Sensorimotor Development in each trimester:
Muscle spindle
1st- muscle starts to differentiate; tissue becomes specialized-
2nd- motor end plate forms; clonus response to stretch
3rd- some muscles are mature and functional, others still maturing
Sensorimotor Development in each trimester:
Touch and tactile system
1st- *first sensory system to develop! Response to tactile stimulus
2nd- receptors differentiate
3rd- touch functional; actual temp discrimination at the end of 3rd trimester; most mature sensory system at birth
Sensorimotor Development in each trimester:
Vestibular system
1st- functioning at the end of first trimester (not completely developed).
(no more!)
Sensorimotor Development in each trimester:
Vision
1st- eyelids fused; optic nerve and cup being formed
2nd- startle to light; visual processing occurs
3rd- fixation occurs; able to focus (fixed focal length)
Sensorimotor Development in each trimester:
Auditory
2nd- Will turn to auditory sounds
3rd- debris in middle ear, loss of hearing
Sensorimotor Development in each trimester:
Olfactory
3rd- nasal plugs disappear, some olfactory perception
Sensorimotor Development in each trimester:
Taste
1st- taste buds develop
3rd- Can respond to different tastes (sweet, sour, bitter, salt)
Sensorimotor Development in each trimester:
Movement
1st- sucking, hiccuping; fetal breathing; quick generalized limb mvmt; positional changes; 7.5 weeks can bend neck and trunk away from perioral stroke
2nd- quickening; sleep states; grasp reflex; reciprocal and symmetrical limb mvmts
3rd- 28 weeks primitive motor reflexes; rooting, suck, swallow; palmar grasp; plantar grasp; MORO; crossed extension
Development of Sensorimotor Integration:
Prenatal period
- responds first to tactile stimuli
- reflex development
- innate tactile, proprioceptive, and vestibular reactions.
Development of Sensorimotor Integration:
Neonatal period
- tactile, proprioceptive, and vestibular inputs are critical from birth onward for the eventual development of body scheme
- vestibular system, although fully developed at birth, continues to be refined and impacts infant’s arousal level (helps infant to feel more organized/content.)
- visual system develops as infant responds to faces and items of high contrast w/in 10 inches of face.
- auditory system is immature at birth and develops as the infant orients to voices and other sounds.
Development of Sensorimotor Integration:
First 6 months
- vestibular, proprioceptive, and visual systems become more integrated and lay foundation for postural control, facilitating a steady visual field
- tactile and proprioceptive systems continue to be refined, laying foundation for somatosensory skills
- visual and tactile systems become more integrated as child reaches and grasps objects, laying foundation for eye-hand coordination
- infant movement patterns progress from reflexive to voluntary and goal-directed
Development of Sensorimotor Integration:
6-12 months
- vestibular, visual, and somatosensory responses increase in quantity/quality as infant becomes more mobile.
- tactile and proprioceptive perceptions more refined, allowing for dev of fine motor and motor planning, and lead to midline skills and crossing midline.
- auditory, tactile, and proprioceptive perceptions are heightened allowing for dev of sounds for the purpose of communicating.
- tactile, proprioceptive, gustatory, and olfactory perceptions are integrated, allowing for primitive self-feeding.
Development of Sensorimotor Integration:
13-24 months
- tacticle perception becomes more precise allowing for discrimination and localization to further refine fine motor skills
- further integration of all systems promotes complexity of motor planning as the toddler’s repertoire of mvmt patterns expands.
- symbolic gesturing and vocalization promotes ideation, indicating the ability to conceptualize.
- Motor planning abilities contribute to self concept as toddler begins to master environment.
Development of Sensorimotor Integration:
2-3 years
- period of refinement as the vestibular, proprioceptive, and visual systems further develop, leading to improved balance and postural control.
- further dev of tactile discrimination and localization leading to improved fine motor skills
- motor planning and praxis ideation also progress during this period.
Development of Sensorimotor Integration:
3-7 years
- child is driven to challenge sensorimotor competencies through roughhouse play, playground activities, games, sports, music, dance, arts/crafts, househodl chores, and school tasks.
- child also learns social development and self esteem through these activities.
Reflexes (onset age, integration age, stimulus, response, relevance):
Rooting
onset 28 weeks gestation
integration 3 months
stimulus- stroke the corner of the mouth, upper lip, and lower lip
response- mvmt of tongue, mouth, and/or head toward stimulus
relevance- allows searching for and locating feeding source
Reflexes (onset age, integration age, stimulus, response, relevance):
Suck-swallow
onset 28 weeks gestation
integration 2-5 months
stimulus- place you index finger inside infant’s mouth with head in midline
response- strong rhythmical sucking
relevance- allows ingestion of nourishment
Reflexes (onset age, integration age, stimulus, response, relevance):
Traction
onset 28 weeks gestation
integration 2-5 months
stimulus- grasp infant’s forearms and pull-to-sit
response- complete flexion of upper extremities
relevance- enhances momentary reflexive grasp
Reflexes (onset age, integration age, stimulus, response, relevance):
Moro
onset 28 weeks gestation
integration 4-6 months
stimulus- rapidly drop infant’s head backward
response- 1st: arm extension/abduction, hand opening. 2nd: arm flexion and adduction
relevance- facilitates ability to depart from dominant flexor posture: protective response
Reflexes (onset age, integration age, stimulus, response, relevance):
Plantar grasp
onset 28 weeks gestation
integration 9 months
stimulus- apply pressure with thumb on the infant’s ball of the foot
response- toe flexion
relevance- increases tactile input to the sole of foot
Reflexes (onset age, integration age, stimulus, response, relevance):
Galant
onset 32 weeks gestation
integration 2 months
stimulus- hold infant in prone suspension, gently scratch or tap alongside the supine with finger, from shoulders to butt
response- lateral trunk flexion and wrinkling of the skin on the stimulated side
relevance- facilitates lateral trunk mvmts necessary for trunk stabilization
Reflexes (onset age, integration age, stimulus, response, relevance):
Asymmetric tonic neck
onset 37 weeks gestation
integration 4-6 months
stimulus- fully rotate infant’s head and hold for 5 seconds
response- extension of extremities on the face side, flexion of extremities on the skull side
relevance- promotes visual hand regard
Reflexes (onset age, integration age, stimulus, response, relevance):
Palmar grasp
onset 37 weeks gestation
integration 4-6 months
stimulus- place your finger in infant’s palm
response- finger flexion; reflexive grasp
relevance- increases tactile input on the palm of the hand
Reflexes (onset age, integration age, stimulus, response, relevance):
Tonic labyrinthine- Supine
onset >37 weeks gestation integration 6 months stimulus- place infant in supine response- increased extensor tone relevance- facilitates total-body extensor tone
Reflexes (onset age, integration age, stimulus, response, relevance):
Tonic labyrinthine- Prone
onset >37 weeks gestation integration 6 months stimulus- place infant in prone response- increased flexor tone relevance- facilitates total-body flexor tone
Reflexes (onset age, integration age, stimulus, response, relevance):
Labyrinthine/optical (head) righting
onset birth-2 months
integration… it persists!
stimulus- hold infant suspended vertically and tilt slowly (about 45 degrees) to the side, forward, or backward
response- upright positioning of the head
relevance- orients head in space; maintains face vertical
Reflexes (onset age, integration age, stimulus, response, relevance):
Landau
onset 3-4 months
integration 12-24 months
stimulus- hold infant in horizontal prone suspension
response- complete extension of head, trunk, and extremities
relevance- breaks up flexor dominance; facilitates prone extension
Reflexes (onset age, integration age, stimulus, response, relevance):
Symmetric tonic neck
onset 4-6 months
integration 8-12 months
stimulus- place infant in the crawling position and extend the head
response- flexion of hips and knees
relevance- breaks up total extensor posture; facilitates static quadruped position
Reflexes (onset age, integration age, stimulus, response, relevance): Neck righting (NOB)
onset 4-6 months
integration 5 years
stimulus- place infant in supine and fully turn head to one side
response- log rolling of the entire body to maintain alignment with the head
relevance- maintains head/body alignment; initiates rolling (first ambulation effort)
Reflexes (onset age, integration age, stimulus, response, relevance): Body righting (on body) (BOB)
onset 4-6 months
integration 5 years
stimulus- place infant in supine, flex one hip and knee toward the chest and hold briefly
response- segmental rolling of the upper trunk to maintain alignment
relevance- facilitates trunk/spinal rotation
Reflexes (onset age, integration age, stimulus, response, relevance): Downward parachute (protective extension downward)
onset 4 months
integration… it persists!
stimulus- rapidly lower infant toward supporting surface while suspended vertically
response- extension of the lower extremities
relevance- allows accurate placement of lower extremities
Reflexes (onset age, integration age, stimulus, response, relevance): Forward parachute (protective extension forward)
onset 6-9 months
integration… it persists
stimulus- suddenly tip infant forward toward supporting surface while vertically suspended
response- sudden extension of the UE, hand opening, and neck extension
relevance- allows accurate placement of UE in anticipation of supporting surface to prevent a fall
Reflexes (onset age, integration age, stimulus, response, relevance): Sideward parachute (protective extension sideward)
onset 7 months
integration… it persists
stimulus- quickly but firmly tip infant off-balance to the side while in sitting position
response- arm extension and abduction to the side
relevance- protects body to prevent a fall; supports body for unilateral use of opposite arm
Reflexes (onset age, integration age, stimulus, response, relevance): Backward parachute (protective extension backward)
onset 9-10 months
integration… it persists
stimulus- quickly but firmly tip infant off-balance backward
response- backward arm extension or arm extension to one side; spinal rotation
relevance- protects body to prevent a fall; unilaterally facilities
Reflexes (onset age, integration age, stimulus, response, relevance):
Prone tilting
onset 5 months
integration… it persists
stimulus- after positioning infant in prone, slowly raise one side of the supporting surface
response- curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms & legs
relevance- maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflexes (onset age, integration age, stimulus, response, relevance):
Supine tilting and Sitting tilting
onset 7-8 months
integration… it persists
stimulus- after positioning infant in supine or sitting, slowly raise one side of the supporting surface
response- curving of the spine toward the raised side (opposite the pull of gravity); abduction/extension of arms & legs
relevance- maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflexes (onset age, integration age, stimulus, response, relevance):
Quadruped tilting
onset 9-12 months
integration… it persists
stimulus- after positioning infant on all fours, slowly raise one side of the supporting surface
response- curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms & legs
relevance- maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflexes (onset age, integration age, stimulus, response, relevance):
Standing tilting
onset 12-21 months
integration… it persists
stimulus- after positioning infant in standing, slowly raise one side of the supporting surface
response- curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs
relevance- maintain equilibrium without arm support; facilitate postural adjustments in all positions
Motor development occurs in which direction?
cephalocaudal/proximal to distal
Motor development progresses from ___ to ___ movement.
gross to fine movement
Motor development progresses from stability to ______ ________.
controlled mobility
Motor development occurs in a spiraling manner, with periods of _______ and ________.
equilibrium and disequilibrium
Sensitive periods of motor development occur when the infant/child is affected by _______ input.
environmental
Handedness is considered to be stable by age…
5 (although strong preferences can be seen much earlier)
Bilateral integration and crossing midline begin around age….
9-12 months
Hand skills…
Reaching skills
1. Visual regard accompanied by swiping/batting, with closed hand and abducted shoulder- age?
2. Hands come together at midline for bilateral reaching with shoulder abducted with partial internal rotation, forearm pronation, and full finger extension- age?
3. Increased dissociation of body sides, allows for unilateral reaching with less abduction and internal rotation of the shoulder, and hand is more open- age?
4. As trunk stability improves, shoulder flexion with slight external rotation, elbow extension, forearm supination, and slight wrist extension begin to emerge- age?
- newborn
- 4 months
- 6 months
- 9 months
Hand skills…
Grasping skills
See other deck with pictures!
Hand skills…
Bilateral hand use
Asymmetric movements until 3 months, then symmetric mvmts emerge until 10 months.
By 12-18 months, baby uses both hands for different functions.
At 18-24 months, manipulation skills emerge
At 2.5 years, ability to use two different hands for two very different functions.
Manipulating skills (Exner's Classification system)- define and age: Finger-to-palm translation
linear mvmt of an object from fingers to palm of hand (ex picking up coins). 12-15 months
Manipulating skills (Exner's Classification system)- define and age: Palm-to-finger translation
with stabilization, a linear movement of an object from palm of hand to fingers (ex planing coins in a slot). 2-2.5 years.
Manipulating skills (Exner's Classification system)- define and age: Shift
a linear mvmt of an object on the finger surfaces to allow for repositioning of the object relative to the finger pads. ex separating 2 pieces of paper (3-5 years), shifting on marker or pencil (5-6+ years).
Manipulating skills (Exner's Classification system)- define and age: Simple rotation
the turning or rolling of an object held at the finger pads approx 90 degrees or less. ex. unscrewing a small bottle cap (2-2.5 years)
Manipulating skills (Exner's Classification system)- define and age: Complex rotation
the rotation of an object 360 degrees. ex. turning a pencil over to erase (6-7 years)
Manipulating skills (Exner's Classification system)- define and age: In-hand manipulation with stabilization
several objects are held in the hand and manipulation of one object occurs, while simultaneously stabilizing the others. ex. picking up pennies with thumb and forefinger while storing them in the ulnar side of the same hand (6-7 years)
Stages of development of scissor skills
2-3 years…
Interest in scissors
Holds and snips with scissors
Opens and closes scissors in controlled fashion
3-4 years…
Manipulates scissors in a forward motion
Coordinates the lateral direction of the scissors
Cuts a straight forward line
Cuts simple geometric shapes
3.5-4.5 years… Cuts circles
4-6 years… cuts simple figure shapes
6-7 years… cuts complex figure shapes
Theorists:
Erikson
Ego adaptation is the adaptive response of the ego in the development of the personality.
8 stages of man include a crisis that when resolved give the individual a sense of mastery and results in acquisition of a personality quality.
1. Basic trust vs mistrust- child realizes need will be met; is hopeful (birth- 18 months)
2. Autonomy vs doubt and shame- child realizes he can control bodily functions (2-4 years)
3. initiative vs guilt- child gains social skills and gender identity; sense of purpose (preschool age)
4. Industry vs inferiority- child gains sense of security through peers and gains mastery over activities of his age group (elementary school age)
5. Self-identity vs role diffusion- teenage beings to make choices about adult roles and with resolution has sense of membership in society (teenage years)
6. Intimacy and solidarity vs isolation- young adult establishes intimate relationship with partner/family; capacity to love (young adulthood)
7. Generativity vs self-absorption- adult finds security in contribution of his chosen personal/professional roles; capacity to care (middle adulthood)
8. Integrity vs despair- mature adult reflection on his value, shares with younger generation; wisdom acquired (maturity)
Theorists:
Kohlberg
Stages of Moral Development
Level 1= preconventional (until age 8)…
stage 1 punishment and obedience (child is obedient to avoid punishment);
stage 2 instrumental relativism (child is moral to benefit self)
Level 2= conventional morality (occurs around 9-10 y/o)…
stage 1 social conformity (child desire to gain approval of others)
stage 2 law and order (rules and social norms internalized)
Level 3= postconventional morality (age varies and not all achieve this level)... Social contracts (young adult has social awareness and awareness of legal implication of decisions/actions)
Theorists:
Maslow
Hierarchy of basic human needs… if lower levels aren’t met, person can’t work on higher levels
a. physiological (food, water, warmth)
b. safety (physical and psychological security)
c. love and belonging (need for affection, emotional support, group affiliation)
d. self-esteem (need to believe in one’s self as competent and valuable member of society)
e. self-actualization (creativity, morality, spontaneity, lack of prejudice, problem-solving skills
Theorists:
Piaget
Cognitive development from birth to adolescence
- sensorimotor period (birth-2 years)…
- preoperational period (2-7 years)
- concrete operations (7-11 years)
- formal operations (11-teens)
Sensorimotor development of gross motor skills (age and what kid does):
Prone position
0-2 months: turns head side to side; lifts head momentarily; bends hips with butt in air; lifts head and sustains in midline; rotates head freely when up; able to bear weight on forearms; able to tuck chin and gaze at hands in forearm prop; attempts to shift weight on forearms, resulting in shoulder collapse
5-6 months: shifts weight on forearms and reaches forward; bears weight and shifts weight on extended arms; legs are closer together and thighs roll inward toward natural alignment; hips are flat on surface; equilibrium reactions are present
5-8 months: airplane posturing on prone position; chest and thighs lift off surface.
7-8 months: pivots in prone position; moves to prone position to sit.
9 months: begins to dislike prone position.
Sensorimotor development of gross motor skills (age and what kid does):
Supine position
0-3 months: head held to one side; able to turn head side to side
3-4 months: holds head in midline; chin is tucked and neck lengthens in back; legs come together
4-5 months: head lag is gone when pulled to a sitting position; hands are together in space.
5-6 months: lifts head indep; brings feet to mouth; brings hands to feet; able to reach for toy with one or both hands; hands are predominantly open
7-8 months: equilibrium reactions are present
Sensorimotor development of gross motor skills (age and what kid does):
Rolling
3-4 months: rolls from prone position to side accidentally b/c of poor control of weight shift; rolls from supine position to side.
5-6 months: rolls from prone to supine; rolls from supine to side with right and left leg performing indep mvmts.
6-14 months: rolls segmentally w/ roll initiated by the head, shoulder, or hips.
Sensorimotor development of gross motor skills (age and what kid does):
Creeping
7 months: crawls forward on belly
7-10 months: reciprocal creep
10-11 months: creeps on hands and feet
11-12 months: creeps well
Sensorimotor development of gross motor skills (age and what kid does):
Sitting
0-3 months (held in sitting): head bobs; back is rounded; hips are apart, turned out, and bent; head steady; chin tucks; sits w/ less support; hips are bent and shoulders are in front of hips.
5-6 months (supports self in sitting): sits alone momentarily; increased extension in back; sits by propping forward on arms; wide base, legs are bent; protective responses present when falling to front.
5-10 months (sits alone): sits alone steadily, initially with wide base of support; able to play with toys while sitting.
6-11 months: gets to sitting position from prone.
7-8 months: equilibrium reactions are present; able to rotate UB while LB remains stationary; protective responses are present when falling to side.
8-10 months: sits well w/o support; legs are closer, knees straight; incr variety of sitting positions incl “w” and side sit; difficult fine motor tasks may prompt return to wide base of support.
9-18 months: rises from supine by first rolling over to stomach then pushing up into 4-point position.
10-12 months: protective ext backwards, first with bent elbows then straight elbows; able to move in and out of sitting position into other positions.
11-12 months: trunk control and equilibrium responses are fully developed in sitting position; further incr in variety of positions possible
11-24+ months: rises from supine by first rolling to side then pushing up to sitting position.
Sensorimotor development of gross motor skills (age and what kid does):
Standing
0-3 months: when held in standing, takes some weight on legs.
2-3 months: when held in standing, legs may give way.
3-4 months: bears some weight on legs, but must be held proximally; head is up in midline, no chin tuck; pelvis and hips are behind shoulders; legs are apart and turned outward.
5-10 months: stands while holding furniture.
5-6 months: incr capability to bear weight; decr support needed, may be held by arms or hands; legs still spread apart and turned outward; bounces in standing position.
6-12 months: pulls to standing position at furniture.
8-9 months: rotates trunk over the LE; LE are more active in pulling to standing position; pulls to standing by kneeling, then half-kneeling.
9-13 months: pulls to standing w/ legs only, no longer needs arms; stands alone momentarily.
12 months: equilibrium reactions are present in standing
Sensorimotor development of gross motor skills (age and what kid does):
Walking
8 months: cruises sideways
8-18 months: walks with two hands held
9-10 months: cruises around furniture, turning slightly in intended direction.
9-17 months: takes indep steps; falls easily
10-14 months: walking; stoops and recovers in play
11 months: walks with one hand held; reaches for furniture out of reach when cruising; cruises in either direction, no hesitation.
15 months: able to start and stop in walking
18 months: seldom falls; runs stiffly with eyes on ground.
Sensorimotor development of gross motor skills (age and what kid does):
Release
0-1 month: no release; grasp reflex is strong
1-4 months: involuntary release
4 months: mutual fingering in midline
4-8 months: transfers object from hand to hand
5-6 months: two-stage transfer; taking hand grasps before releasing hand lets go
6-7 months: one-stage transfer; taking hand and releasing hand perform actions simultaneously
7-9 months: volitional release
7-10 months: presses down on surface to release
8 months: releases above a surface with wrist flexion
9-10 months: releases into a container with wrist straight
10-14 months: clumsy release into small container; hand rests on edge of container
12-15 months: precise, controlled release into small container with wrist extended.
Sensorimotor development of gross motor skills (age and what kid does):
Stair climbing
15 months: creeps up stairs
18-24 months: walks up and down stairs while holding on.
18-23 months: creeps backwards down stairs.
2-2.5+ years: walks up and down stairs without support, marking time.
2-3 years: walks up stairs, alternating feet.
3-3.5 years: walks down stairs, alternating feet
Sensorimotor development of gross motor skills (age and what kid does):
Jumping and hopping
2 years: jumps down from step 2.5+ years: hops on one foot, few steps 3 years: jumps off floor with both feet 3-5 years: jumps over objects 3.5-5 years: hops on one foot 3-4 years: gallops, leading with one foot and transferring weight smoothly and evenly 5 years: hops in straight line 5-6 years: skips on alternating feet, maintaining balance
Major milestones in cognitive development (age):
Early object use…
child focuses on action performed with objects (ex banging, shaking)
3-6 months
Major milestones in cognitive development (age):
Early object use…
child explores characteristics of objects and expands the range of schemes (ex pulling, turning, poking)
6-9 months
Major milestones in cognitive development (age):
Early object use…
child combines objects in relational play, such as objects in containers
8-9 months
Major milestones in cognitive development (age):
Early object use…
child notices relation b/w complex actions and consequences such as opening doors, placing lids on containers, and differential use of schemes based on toy being played with (rolling a train)
9-12 months
Major milestones in cognitive development (age):
Early object use…
child acts on objects with variety of schemes
12 months+
Major milestones in cognitive development (age):
Early object use…
child links multi-scheme combinations into a meaningful sequence, ex putting food in a bowl, scooping food using spoon, and feeding a doll
24-36 months (2-3 years)
Major milestones in cognitive development (age):
Early object use…
child links schemes into complex scrips
36-42 months (3-3.5 years)
Major milestones in cognitive development:
Problem Solving skills at age 6-9 months…
- child finds object after watching it disappear (toy covered in cloth)
- child uses movement as a means to an end (rolling to get toy)
- child anticipates movement of objects in space (looking toward trajectory of object circling child’s head)
- child attends to consequences of actions (banging toy and realizing it makes noise)
- child repeats actions to repeat consequences (banging toy to hear noise)
Major milestones in cognitive development:
Problem Solving skills at age 9-12 months…
- child able to use tool after demonstration (using stick to get a toy that is out of reach)
- child’s behavior becomes more goal directed
- child performs an action to produce a response
Major milestones in cognitive development:
Problem Solving skills at age 12-15 months…
- child recruits the help of adult to achieve a goal
- child attempts to activate a simple mechanism
- child turns and inspects objects.
- child uses trial and error approach to new challenges
Major milestones in cognitive development:
Problem Solving skills at age 18-21 months…
- child attends to shapes of things and uses them appropriately.
- child beings to think before acting
- child uses tool to obtain a favored object
- child begins to replace trial and error w/ thought process in order to attain goal
- child can operate a mechanical toy (an on-off switch)
- child can predict effects of presume causes.
Major milestones in cognitive development:
Problem Solving skills at age 21-24 months
- child recognizes operations of several mechanisms
- child matches circles, squares, triangles, and manipulates objects into small openings (shape sorters)
Major milestones in cognitive development:
Problem Solving skills at age 24-27 months
-child discriminates sizes
Major milestones in cognitive development:
Problem Solving skills at age 24-30 months
-child can build with blocks horizontally and vertically
Major milestones in cognitive development:
Problem Solving skills at age 27-30 months
- child begins to relate experiences to one another, based on logic and knowledge of prior experiences
- child can make a mental plan of action without acting it out
- child can see relationships between experiences 9if the balloon is popped, it will make a loud noise)
Major milestones in cognitive development:
Problem Solving skills at age 36-48 months (3-4years)
- child can build a tower of nine cubes, demonstrating balance and coordination
- child can organize objects by size and build a structure from a mental image
Major milestones in cognitive development:
Problem Solving skills at age 48-60 months (4-5 years)
- child can build involved structures combing various planes, along with symmetrical designs
- child is able to utilize spatial awareness, cause-and-effect, and mental images in problem solving
Major milestones in cognitive development:
Symbolic play skills at age 12-16 months
basic “make believe” play, primarily involving self; ex eating, sleeping
Major milestones in cognitive development:
Symbolic play skills at age 12-18 months
- child can project “make believe” play on objects and others
- child uses a variety of schemes in imitating familiar activities
Major milestones in cognitive development:
Symbolic play skills at age 18-24 months
- child increases the use of non-realistic objects in pretending (ex substituting a block for a train.)
- child has inanimate objects perform familiar activities (ex a doll washing itself)
Development of Play (age and actions):
Exploratory play
0-2 years
- child engages in play experiences through which the child develops a body scheme
- sensory integrative and motor skills are also developed as the child explores the properties and effects of actions on objects and people
- child plays mostly with parents/caregivers
Development of Play (age and actions):
Symbolic play
2-4 years
- child formulates, tests, classifies, and refines ideas, feelings, and combined actions
- this form of play is associated with language development
- objects that are manageable for child in terms of symbolization, control, and mastery are preferred by the child.
- child is mostly involved in parallel play with peers and begins to becomes more cooperative over time.
Development of Play (age and actions):
Creative play
4-7 years
- child engages in sensory, motor, cognitive, and social play experiences in which child refines relevant skills
- child explores combinations of actions on multiple objects
- child begins to master skills that promote performance of school and work related activities
Development of Play (age and actions):
Games
7-12 years
- child participates in play with rules, competition, social interaction, and opportunities for development of skills
- child beings to participate in cooperative peer groups with a growing interest in competition
- friends become important for validation of play items and performance, while parents assist and validate in absence of peers.
Eating and Feeding performance: Takes cereal or poured baby food from spoon
5-7 months
Eating and Feeding performance: attempts to hold bottle but may not retrieve if it falls; needs to be monitored for safety reasons.
6-8 months
Eating and Feeding performance: holds and tries to eat cracker but sucks on it more than bites it;
consumes soft foods that dissolve in mouth;
grabs at spoon but bangs it or sucks on either end of it
6-9 months
Eating and Feeding performance: finger-feeds self a portion of meals consisting of soft table foods (macaroni, peas, dry cereal) and objects if fed by an adult
9-13 months
Eating and Feeding performance: dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon before it goes into mouth
12-14 months
Eating and Feeding performance: scoops food with spoon and brings it to mouth
15-18 months
Eating and Feeding performance: demonstrates interest in using fork; may stab at food; proficient with spoon and eats cereal with milk
24-30 months (2 years)
Intervention for oral motor control: positioning of body
neutral pelvic alignment and trunk stability with child sitting in caregiver’s lap or infant seat/wc.
avoid head extension to prevent asphyxiation as a result of closing airway
Intervention for oral motor control: hand positioning of caregiver
index finger longitudinally under child’s lip, middle finger under jaw, and thumb on lateral end of mandible
Intervention for oral motor control: facilitate lip closure by…
applying slight upward pressure of index finger under child’s lip
Intervention for oral motor control: facilitate jaw closure by…
firm upper pressure of the middle finger under the jaw
Intervention for oral motor control: hand positioning of index and middle fingers to assist in inhibiting tongue thrust, press bowl of spoon…
downward and hold on tongue
Intervention for oral motor control: facilitate swallow by…
lip closure and placement and slight downward pressure of spoon on middle aspect of tongue
Intervention for oral motor control: facilitate chewing by…
placement of foods between gum and teeth
Intervention for oral motor control: integrate preventive measures to work out of abnormal patterns. Measures…
- provide firm downward pressure, using a spoon, on middle aspect of tongue in presence of tonic bite reflex
- prevent tongue retraction to avoid choking
- facilitate lip closure for a tongue thrust that can result in loss of liquid/food, drooling, and failure to thrive
- decrease tactile sensitivity prior to feeding by providing firm pressure; encourage sucking.chewing on cloth; rub gums, palate, and tongue; promote oral exploration of toys; vary texture of foods, gradually introducing mashed potatoes mixed w/ other vegis and soft meats.
Development of self-dressing skills: 1 y/o
- cooperates with dressing (holds out arms/feet)
- pulls off shoes, removes socks
- pushes arms through sleeves and legs through pants
Development of self-dressing skills: 2 y/o
- removes unfastened coat
- removes shoes if laces are untied
- helps pull down pants
- finds armholes in pullover shirt
Development of self-dressing skills: 2.5 y/o
- removes pull-down pants w/ elastic waist
- assists in pulling on socks
- puts on front-button coat or shirt
- unbuttons large buttons
Development of self-dressing skills: 3 y/o
- puts on pullover shirt with min A
- puts on shoes w/o fasteners (maybe wrong foot)
- puts on socks (maybe heel up)
- Indep pulls down pants
- zips/unzips jacket once on track
- needs A to remove pullover shirt
- buttons large front buttons
Development of self-dressing skills: 3.5 y/o
- finds front of clothing
- snaps/hooks front fastener
- unzips front zipper, separating zipper
- puts on mittens
- buttons series of 3 or 4 buttons
- unbuckles shoe/belt
- dresses with supervision (help w/ front and back)
Development of self-dressing skills: 4 y/o
- removes pullover indep
- buckles shoes/belt
- zips jacket
- puts on socks correctly
- puts on shoes with A in tying laces
- laces shoes
- consistently identifies front/back of garment
Development of self-dressing skills: 4.5 y/o (1 thing)
puts belt in loops
Development of self-dressing skills: 5 y/o
- ties and unties knots
- dresses unsupervised
Development of self-dressing skills: 6 y/o
- closes back zipper
- ties bows
- buttons back buttons/ snaps back snaps
Development of toileting skills: 1 y/o
- indicates discomfort when wet/soiled
- has regular BM
Development of toileting skills: 1.5 y/o
sits on toilet when placed there and supervised (short time)
Development of toileting skills: 2 y/o
urinates regularly
Development of toileting skills: 2.5 y/o (lots)
- achieves regulated toileting with occasional daytime accidents
- rarely bowel accidents
- tells someone when needs to go
- may need reminders to go to bathroom
- may need help with getting on toilet
Development of toileting skills: 3 y/o
- goes to bathroom indep; seats himself on toilet
- may need help wiping
- may need help w/ fasteners
Development of toileting skills: 4-5 y/o
Indep in toileting (tearing TP, flushing, washing hands, managing clothing)
Development of home management skills: 13 months
imitates housework
Development of home management skills: 2 y/o
picks up and puts away toys w/ reminders; copies parents domestic activities
Development of home management skills: 3 y/o
- carries things w/out dropping
- with help can dust, dry dishes, garden
- puts toys away w/ reminders
- wipes up spills
Development of home management skills: 4 y/o
- fixes dry cereal and snacks
- helps with sorting laundry
Development of home management skills: 5 y/o
- puts away toys neatly
- makes a sandwich
- takes out trash
- makes bed
- puts dirty clothes in hamper
- answers telephone correctly
Development of home management skills: 6 y/o
- does simple errands
- does household chores without redoing
- cleans sink
- washes dishes with help
- crosses street safely
Development of home management skills: 7-9 y/o
- beings to cook simple meals
- puts clean clothes away
- hangs up clothes
- manages small amounts of money
- uses telephone correctly
Development of home management skills: 10-12 y/o
- cooks simple meals with supervision
- does simple repairs with appropriate tools
- beings doing laundry
- sets table
- washes dishes
- cares for pet with reminders
Development of home management skills: 13-14 y/o
- does laundry
- cooks meals
APGAR score includes ______ (list) items measured at (times) ________ and highest possible score is _____.
- heart rate, respiration, reflex irritability, muscle tone, and color.
- 1, 5, & 10 minutes after birth
- 10 (highest possible score)
Assessments (focus, method, scoring, population):
Assessment of Preterm Infants’ Behavior (APIB)
- focus- assesses infant’s pattern of developing behavioral organization in response to increasing sensory and enviro stimuli. Its an extension/refinement of the Neonatal Behavioral Assessment Scale (NBAS)
- method- behavior checklist and scale
- scoring- obtain scores prior to admission for baseline, during administration, and following administration; eye mvmts measured, fn and integration of physiological, motor, state, attn, and regulation are determined; scores allow OT to plan interventions, measure outcomes, and plan follow-up
- population- pre-term and full-term infants
Assessments (focus, method, scoring, population):
Neurological Assessment of Pre-term and Full-term New-born Infant (NAPFI)
- focus- rating scale consisting of brief neuro exam incorporated into routine assessment; can be used in incubator/ventilator if baby can be handled; tests habituation, mvmt/tone, reflexes, and neurobehavioral responses (state transition, level of arousal/alertness, auditory/visual orientation, irritability, consolability, and cry).
- method- itmes administered in sequence: first quiet/sleep state, then check items not influenced by state, then awake state.
- scoring- state recorded for each item; scores allow therapist to doc a pattern of responses to reflect neuro functions and identify deviations for diagnosis.
- population- pre-term and full-term newborn infants.
Assessments (focus, method, scoring, population):
Denver Developmental Screening Test II
- focus- standardized task performance and observation screening tool for early id of children at risk for dev delays in 4 areas (person-social, fine motor-adaptive, language, and gross motor)
- method- 125 test items; items below child’s chronological age are administered w/ sequential progression toward higher items until child fails three times. behaviors observed are marked on checklist; questionnaires for home screening of enviro are available for parents.
- scoring- the score allows for interpretation of a child’s performance in terms of being normal, abnormal, questionable, or unstable in the four areas.
- population- 1 month to 6 years
Assessments (focus, method, scoring, population):
Bayley Scales of Infant Development, 3rd ed (BSID-III)
- focus- rating scales that assess multiple areas of dev to attain a baseline for intervention and monitor progress. evals 5 domains (cognitive, language, motor, social-emotional, adaptive behavior skills)
- method- age appropriate items selected from items on different domain scales; parent completes two questionnaires
- scoring- composite scores yield qualitative descriptors; results used to plan interventions.
- population- 1-42 months
Assessments (focus, method, scoring, population):
First STEP Screening Test for Evaluating Preschoolers
- focus- checklist and rating scale which identifies preschool students at risk and in need of more comprehensive eval.
- method- assesses 5 areas as identified by IDEA (cognition, communication, physical, social/emotional, and adaptive functioning. Table-top tasks and gross motor tasks; social/emo and adaptive behavior assessed by OT during tasks; optional parent-teacher scale.
- scoring- total scores converted to composite to determine if child’s perf is within acceptable level or if child is at risk; guides tx planning.
- population- 2 years 9 mo - 6 years 2 mo.
Assessments (focus, method, scoring, population):
Hawaii Early Learning Profile, revised (HELP)
- focus- non-standardized scale of developmental levels. Educational curriculum-referenced test that assesses 6 areas (cognitive, language, gross motor, fine motor, social/emo, and self-help).
- method- admin in child’s enviro in context of family during typical routines; dev appropriate items administered.
- scoring- dev age range levels of skills in each of six areas are approximated; description of behavior and possible causes of difficulty.
- population- birth- 3y/o, w/ dev delay, disability, or at risk. Preschool version avail for ages 3-6.
Assessments (focus, method, scoring, population):
Miller Assessment for Preschoolers (MAP)
- focus- standardized task performance screening tool to assess sensory and motor abilities (coordination, cognitive abilities- verbal and nonverbal- and complex tasks)
- method- items administered that relate to age of child.
- scoring- measures obtained and scores compared to norms to give percentile for each index; used for tx plan.
- population- 2 years 9 mo- 5 years 8 mo
Assessments (focus, method, scoring, population):
Pediatric Evaluation of Disability Inventory (PEDI)
- focus- standardized behavior checklist and rating scale assesses capabilities and detects functional deficits, determine dev level, monitor child’s progress, and complete program eval.
- method- observation, interview, and scoring of 3 domains (self-care, mobility, and social skills)
- scoring- identified children with patterns of delay; progress and outcomes can be monitored.
- population- 6 months- 7.5 years
Assessments (focus, method, scoring, population):
Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
- focus- standardized test assesses overall motor proficiency (fine and gross)
- method- long and short form with 8 subtests (fine motor precision, fine motor integration, manual dexterity, bil coord, balance, running speed and agility, upper limb coor and strength)
- scoring- total motor composite score in 4 areas (fine manual control, manual coord, body coord, and strength/agility); age equivalency and descriptive categories indicate strengths/weaknesses; basis for tx goals and eval change.
- population- 4 years- 21 years
Assessments (focus, method, scoring, population):
Erhardt Developmental Prehension Assessment (EDPA)
- focus- observation checklist based on perf which assesses 3 areas (involuntary arm-hand patterns, vol movements of approach, and prewriting skills).
- method- test admin in sections according to appropriate age level; 341 test components
- scoring- 1. R and L hand scores as normal or emerging/abnormal; 2. scores placed into dev level for each cluster; 3. fn determined for involuntary arm-hand patterns, vol mvmts, and prewriting skills. Gaps in hand skills can dev levels can be determined; used for tx planning.
- population- children of all ages and cognitive levels w/ neurodevelopmental disorders.
Assessments (focus, method, scoring, population):
Peabody Developmental Motor Scales (2nd ed) (PDMS-2)
- focus- standardized rating scales of gross and fine motor dev.
- method- subtests measure reflexes, sustained control, locomotion, object manipulation, grasping, and visual motor integration; items admin one level below child’s expected motor age to obtain a basal age level; test discontinued with 3 consecutive scores of 0.
- scoring- developmental profile of gross and fine motor skills; strengths/weaknesses identified; motor activity program useful for training is provided.
- population- birth- 6 years with motor, speech, and/or hearing disorders
Assessments (focus, method, scoring, population):
Toddler and Infant Motor Evaluation (TIME)
- focus- assesses quality of mvmt
- method- 5 subtests (mobility, stability, motor organization, social/emo abilities, and functional performance); quality rating, component analysis, and atypical positions can be assessed by OTs with advanced training.
- scoring- cutoff scores indicative of moderate or significant motor delays
- population- birth- 3 years 6 mo
Assessments (focus, method, scoring, population):
Beery-Buktenica Developmental Test of Visual Motor Integration- VMI, 6th ed
- focus- assesses visual motor integration; can be used as classroom screening tool
- method- child copies 24 geometric forms; once fails to meet criteria for 3 consecutive then test discontinued.
- scoring- raw score translated to percentile ranks, standard score, and age equivalency.
- population- 2-18 years
Assessments (focus, method, scoring, population):
Developmental Test of Visual Perception, 2nd ed (DTVP-2)
and DTVP-A (adolescent/adult)
- focus- assesses visual perceptual skills and visual motor integration for levels of perf and useful for designing interventions and monitoring progress.
- method- DTVP-2 has 8 subtests (eye-hand coord, copying, spatial relations, visual-motor speed, position in space, figure-ground, visual-closure, form constancy. DTVP-A has 4 subtests (VMI, composite index, and motor-reduced visual perception composite index)
- scoring- raw scores, age equivalents, percentiles, subtest standard scores, and composite quotients. 3 indexes provided: general visual perceptual, motor-reduced visual perception, visual motor integration.
- population- children 4-10 years (DTVP-2); ages 11-74 years (DTVP-A)
Assessments (focus, method, scoring, population):
Erhardt Developmental Vision Assessment (EDVA) and short screening form (EDVA-S)
- focus- behavior rating scale to determine visuomotor dev that assesses involuntary visual patterns including eyelid reflexes, pupillary reactions, doll’s eye responses, and voluntary patterns including fixation, localization, ocular pursuit, and gaze shift.
- method- 271 test items organized into 7 clusters, clusters presented sequenced developmentally; response scored for each eye.
- scoring- responses scored as normal, well-integrated, emerging, or not present; developmental level provided for each cluster and final dev level estimated. (short form has 67 components). Findings determine indications for ophthalmic eval.
- population- birth to 6 months. (EDVA-S can be used for older children)
Assessments (focus, method, scoring, population):
Preschool Visual motor Integration Assessment (PVMIA)
- focus- standardized norm referenced assessment evaluates VMI and visual perceptual skills, including perception in space, awareness of spatial relationships, color and space discrimination, matching two attributes simultaneously and the ability to reproduce what is seen and interpreted.
- method- 2 performance subtests and 2 behavioral observation checklists: drawing subtest (reproduce lines/shapes), block patterns subtest (recognize color/shape and reproduce block patterns and match using 3-D blocks), section to determine if child as requisite skills to continue.
- scoring- fine motor and visual perceptual abilities examined separately. percentile ranges; behavioral observations not included in score, only test interpretation and tx planning.
- population- age 3.5- 5.5 years
Assessments (focus, method, scoring, population):
Motor-Free Visual Perception Test (MVPT-3)
- focus- standardized, quick eval to assess visual perception (excludes motor) in 5 areas (spatial relations, visual discrimination, figure-ground, visual closure, and visual memory)
- method- number of items administered depends on child’s age.
- scoring- raw score translated to perceptual ages and perceptual quotients.
- population- ages 4-95 years
Assessments (focus, method, scoring, population):
Motor-Free Visual Perception Test-Vertical (MVPT-V)
- focus- eval of person with spatial deficits, due to hemi-field visual neglect or abnormal visual saccades
- method- 36 items vertically placed used to assess spatial relationships, visual discrimination, figure ground, visual closure, and visual memory (excluding motor)
- scoring- provides perceptual ages
- population- children and adults with visual field cuts or w/out visual impairments (appropriate for brain injury since it confounding variable).
Assessments (focus, method, scoring, population):
Test of Visual-Motor Skills (TVMS) and
Test of Visual-Motor Skills: Upper Level (TVMS- UL)
- focus- assesses eye-hand coordination skills for copying geometric designs
- method- person copies and draws geometric designs which become sequentially more complex. 23 geometric forms in TVMS scored for 8 possible errors; 16 forms in TVMS:UL scored for 9-22 possible errors in motor accuracy, motor control, motor coordination, and psychomotor speed.
- scoring- score translated to motor age, standard score, and percentile rank. Drawing errors provide clinical info; used to establish tx plan.
- population- TVMS 2-13 years; TVMS:UL 12-40 years.
Assessments (focus, method, scoring, population):
Test of Visual-Perceptual Skills, 3rd ed (TVPS3)
- focus- assesses visual-perceptual skills and differentiates these from motor dysfunction, as a motor response is not required.
- method- 7 visual-perceptual skills (visual discrimination, visual memory, visual-spatial relations, visual form constancy, visual sequential memory, visual figure-ground, and visual closure). Multiple choice format and sequenced in complexity; 3 consecutive errors discontinue test.
- scoring- indications of visual perceptual problems determined by standard scores and percentile ranks.
- population- 4-19 years.
Assessments (focus, method, scoring, population): Sensory Profile (SP): Infant/Toddler Sensory Profile
- focus- measures reactions to daily sensory experiences.
- method- caregiver questionnaire obtains caregiver’s judgment and observation of a child’s sensory processing, modulation, and behavioral and emotional responses in each sensory system.
- scoring- cutoff scores indicate typical performance and probable, definite, and significant differences, and indicates which sensory system in hindering performance. used for tx planning
- population- birth to 3 years
Assessments (focus, method, scoring, population): Sensory Profile (SP): Adolescent/Adult Sensory Profile
- focus- allows clients to identify their personal behavioral responses and develop strategies for enhanced participation.
- method- questionnaire measures individual’s reactions to daily sensory experiences.
- scoring- cutoff scores indicate typical performance and probable, definite, and significant differences. indicates which sensory system is hindering performance; used for tx planning.
- population- 11-65 years old
Assessments (focus, method, scoring, population):
Childhood Autism Rating Scale (CARS)
- focus- determines the severity of autism (mild, mod, or severe) and distinguishes children with autism from children with developmental delays who do not have autism.
- method- observational tool to rate behavior; 15 descriptive statements include characteristics, abilities, and behaviors that deviate from norm.
- scoring- below 30= no autism; 31-36.5= mild to mod autism; 37-60= severe autism.
- population- children over 2 years who have autism
Assessments (focus, method, scoring, population):
Coping Inventory and Early Coping Inventory
- focus- assess coping habits, skills, and behaviors, including effectiveness, style, strengths, and vulnerabilities to develop tx plans for coping skills.
- method- Coping Inventory is questionnaire assesses coping with self and coping with enviro according to 3 categories of coping styles (productive, active, and flexible). Early Coping Inventory is questionnaire assesses effectiveness of behaviors according to sensorimotor organization, reactive behavior, and self-initiated behavior.
- scoring- determines level of adaptive behavior and wheter or not tx is needed.
- population- Coping Inventory- 15+ years; Early Coping Inventory- 4-36 months
Assessments (focus, method, scoring, population):
Play History
- focus- assesses play behavior and play opportunities
- method- primary caregiver provides info about 3 categories (general info, previous play experience, and actual play that occurs over three days of play). addresses form and content of behavior, analyzed according to materials, action, people, and setting.
- scoring- play dysfunction is determined; tx plan developed based on strengths/deficits.
- population- children and adolescents
Assessments (focus, method, scoring, population):
Revised Knox Preschool Play Scale (RKPPS)
- focus- observations of play skills to differentiate developmental play abilities, strengths & weaknesses, and interest areas.
- method- natural indoor/outdoor enviro with peers; 2 30-min observations; 4 dimensions of play assessed (space management, material management, pretense/symbolic (including imitation), and participation).
- scoring- 4 dimensions described; mean scores of all four dimension scores provide play age score indicative of child’s play maturity; effectiveness of tx can be determined.
- population- 0-6 years
- note: this one useful with kids for whom standardized testing may not be appropriate.
Assessments (focus, method, scoring, population):
Test of Playfulness (ToP), revised version 3.5
- focus- assesses child’s playfulness based on observations according to 4 aspects of play (intrinsic motivation, internal control, disengagement from constraints of reality, and framing).
- method- observation. Extent, intensity, and skillfulness of play also observed/rated.
- scoring- scores in 25th percentile or below indicate need for intervention.
- population- 15 months-10 years.
Assessments (focus, method, scoring, population):
Transdisciplinary Play-Based Assessment (TPBA)
- focus- measures child’s development, learning style, interaction patterns, and behaviors to determine need for services.
- method- non-standardized play assessment employing team observations based on six phases. observations categorized into developmental domains of cognitive, social-emo, communication and language, and sensorimotor
- scoring- program plan is developed and can include dev levels, family assessment, intervention services and strategies to promote appropriate activity enviro.
- population- infancy-6 years
Assessments (focus, method, scoring, population): Participation Scale (P Scale) version 6.0
- focus- a measure of restrictions in social participation related to community mobility, access to work, recreation, and social interaction with family, peers, etc.
- method- 18-item questionnaire addressing 9 domains of participation from ICF. Self-care, mobility, and social function and their functional sub-units are assessed.
- scoring- scores above 12 on scale (0-90) indicate need for tx.
- population- 15 years+ with physical disabilities
Assessments (focus, method, scoring, population):
School Function Assessment (SFA)
- focus- assesses and monitors functional performance in order to promote participation in a school environment. does not measure academic performance.
- method- criterion referenced questionnaire assesses: level of participation, type of support currently required, and performance on school related tasks.
- scoring- basic level of criterion cutoff scores; advanced level scores indicate appropriate grade level functioning.
- population- grades K-6
Theorists:
Havighurst
- People need to develop certain skills at different ages to meet social standards.
- developmental tasks rely on biological, psychological, and sociological conditions.
- there are sensitive periods when conditions are optimal for accomplishment of a developmental task
- 6 stages of development: infancy/childhood, middle childhood, adolescence, early adulthood, middle adulthood, later adulthood.
Theorists:
Llorens
- individual is view from two perspectives: specific period of time, referred to as horizontal development; over the course of time, referred to as longitudinal/chronological development
- both perspectives occur simultaneously
- integration of these two aspects is critical to normal development
- role of OT is to facilitate development and assist with mastery of life tasks and ability to cope with life.
- this FOR integrated many of Gesell, Amatruda, Erikson, Havighurst, and Freud.
Theorists:
Mosey
- Recapitulation of ontogenesis FOR. (The development of adaptive skills, essential learned behaviors, is considered critical for successful participation in occupational perf.)
- 6 major adaptive skills: sensory integration of vestibular, proprioceptive, and tactile info; cognitive skills (perceive, represent, and organize sensory info to think/problem solve); dyadic interaction skill (ability to participate in variety of dyadic relationships- family, playmate, superior, friend, peer, intimate); group interaction skill; self-identity skill (self as autonomous, holistic, and acceptable; sexual identity skill.
Types of child abuse (4)
physical
emotional or mental
sexual
neglect
General signs of abuse
withdrawal nightmares running away anxiety or depression guilt mistrust of adults fear aggressiveness
Signs and symptoms of physical abuse
child reports being physically mistreated
unexplained injuries; repeated injuries
abrasions and lacerations
small circular burns (cigarette)
burns with donut shape on butt (scalding) or any burn that shows pattern of object used
friction burns (rope)
unexplained fractures
denial, unlikely explanations, or delays in tx by caregiver
Signs and symptoms of emotional or mental abuse
child reports being verbally/emotionally mistreated
aggressive or acting out behavior like lying or stealing
shy, dependent, or defensive appearance
verbally abuses others with language that may’ve been used toward them.
Signs and symptoms of sexual abuse
child reports being inappropriately touched
abuse may be physical, non-physical, or violent
precocious sexual behavior or knowledge
copying adult sexual behavior
inappropriate sexual behavior
reluctance/refusal to let caregivers wash parts of body
Signs and symptoms of neglect
poorly nourished appearance or inadequately clothed
consistently tired or listless behavior
inconsistent attendance at school
poor hygiene or obsession with cleanliness
left alone in dangerous situations
unable to relate well to adults or form friendships
