Normal psychomotor development Flashcards
What is psychomotor development?
The progressive attainment of skills that involve both mental and muscular activity
What are the 2 prominent stages of psychomotor development?
- Formation of neural tube
- Development of prosencephalon
Describe primary neurulation
- Process by which neural tube folds
- ~3-4 weeks of gestation
- NS begins in dorsal aspect of embryo as a plate of tissue
- 2 lateral folds develop either side of neural plate
- Then fold over and form neural crest
- Epidermis forms, covering neural tube, which is now discrete
- Occurs caudally
Disturbances in primary neurulation can lead to errors in neural tube development. What is anencephaly?
- Failure of anterior end of neural tube to fold
- Meninges + skull don’t form, most common type involves forebrain
- Hypothalamus + brain in contact with amniotic fluid
- 75% stillborn, rest die in neonatal period
What is myelomeningocele?
- Post tube defect, caudal part doesn’t close
- Worst type of spina bifida
- Lumbo-sacral commonly affected, sometimes thoracic lesions
- Can get hydrocephalus higher up
- Paralysis of legs as well
What is holoprosecephaly?
- Prosencephalon doesn’t split as it should
- Remains as one sphere
- Result in facial defects
- No cleavage in the middle - single ventricle in middle
- Happens ~5-6 wks gestation
What 4 events occur in the CNS after the neural tube has formed and cleavage/midline formation has occured?
- Neuronal proliferation
- Neuronal migration
- Neuronal organisation
- Myelination
These processes happen from second month of gestation right up until adult life
When is brain growth quickest?
- Grows quickly before birth
- Continues to grow quickly till 1 years of age
- Starts to level off by 2 years of age (75% of adult weight)
- Further development in puberty
- Declines as we get older
When do synapses achieve maximum density?
at 6-12 months after birth
What is neurodevelopment like at birth?
- Cerebral cortex primitive
- Neurons poorly connected
What is meant by the physical growth of the nervous system?
Myelination of nerves and an increase in number of connections between cells. Myelination progresses: nervous control of various functions improve, continues throughout childhood.
What is meant by ‘biological influences’ on development?
- Inherited characteristics eg. cognitive potential and temperament
- Antenatal + perinatal history
- General health
- Vision + hearing (sensory systems)
What is meant by ‘environmental influences’ on development?
- Opportunities such as sensitive and supportive parenting + education
- Threats such as social + economic deprivation
- Experience and encouragement
What are 5 characteristics of development?
- Innate
- Incremental
- Progressive
- Responsive to stimuli
- Interdependent
What is meant by developmental milestones?
The age at which major skills that are crucial to a child’s progress in each of the 4 spheres of development are achieved
What are the 8 areas of child development?
- Gross motor skills
- Fine motor skills
- Language comprehension
- Expressive language
- Hearing
- Vision
- Behaviour + emotional development
- Social skills
*grouped in pairs, all relate with each other
What gross motor skills do newborns posess?
Reflex head turn; moves head side to side
At what age can/should a baby do the following:
- roll back to front
- crawl
- cruises
- walks
- runs/kicks a ball
- walk up + down stairs
- skips
- 5 months: roll back to front
- 7-8 months: crawls/sits well
- 10-11 months: cruises
- 12 months: walks
- 18 months: runs/kicks a ball
- 2 yrs: can walk up + down stairs (1 step at a time)
- 5 yrs: skips
Most babies follow the sequence of gross motor skills but a small number of children will for example bottom-shuffle instead of crawl - is this normal?
Yes, there is a 9% incidence of bottom shuffling in comparison to crawl/stand/walk being 83%.
Bottom shuffling is inherited and if a child is a bottom-shuffler, they tend to walk alone slightly later but it is a normal pattern.
Describe the fine motor/adaptive skills of a baby at certain points
- 1 m: tracks horizontally to midline
- 3 m: unfisted for >50% of time; tracks 180 degrees; visual threat
- 5 m: ‘rakes’ at bright object
- 6 m: transfers object from 1 hand to other
- 7 m: 3 finger pincer grip
- 9 m: fine/neat pincer grip
- 14 m: tower of 2 cubes, scribbles spontaneously
- 18 m: tower of 4 cubes
- 2 yr: copies line
- 3 yr: copies circle
- 6 yr: copies triangle
Give examples of primitive reflexes - when do they last till?
- Moro reflex
- Rooting
- Sucking
- Grasp
- Stepping
- ATNR (asymmetrical tonic neck reflex/fencing reflex)
Primitive reflexes begin to diminish at about 6 months as postural reflexes take hold as well as definitive motor actions
Describe at what ages babies acquire language skills
- newborn: alerts to bell
- 2 m: cooing; searches w eyes for sound
- 4 m: turn head to sound; laughs
- 6 m: babbles
- 8 m: mama/dada nonspecific
- 9 m: understands “no”
- 12 m: mama/dada specific, 3-5word vocab
- 16 m: can point to several body parts
- 2 yr: 50 word vocab, 2 word sentences
- 2.5 yr: gives first + last names; uses plurals
- 3 yr: 250 word vocab, intelligble speech 75% time to strangers
Describe at what ages babies acquire personal/social skills
- newborn: regards face
- 6wk: spontaneous social smile
- 6 m: discriminates social smile
- 7 m: stranger anxiety, peek-a-boo
- 12 m: drinks from cup
- 15-18 m: uses spoon, spills
- 2 yr: washes + dries hands
- 3 yr: uses spoon well, buttons
- 4 yr: washes + dries face; engages in cooperative play
- 5 yr: dresses without assistance
What would you be worried about if a baby wasn’t smiling at 6-8weeks?
- Vision problems
What is meant by developmental scales being ‘interdependent’?
- Eg. fine motor skills are dependent on gross motor skills coming beforehand
- Gross motor skills dependent on vision
- Social skills dependent on vision
- Hearing skills dependent on gross motor skills
What is developmental delay?
Failure to acquire a particular developmental skill at an age when 95% of peers have done so
What are the 2 types of developmental delay?
- Global delay
- Specific delay
What is global delay and causes for this?
- Delay in 2 or more areas of development
- Widespread problem of brain structure:
- Genetic
- Asphyxial
- Infective
- Trauma
- Widespread problem of sensory input:
- Severe neglect
What is specific delay? Examples?
- To do with 1 specific part of brain eg. speech delay, some blindness
- Defect of effector units eg. myopathies, neuropathies
- Defect of sensory organs eg. blindness, deafness
How often are babies screened?
- Newborn - every baby has it
- 6 weeks - done by GP
- 6-9 months - by health visitor
- 18 months - by health visitor
- 3 years - just before school
How would you assess the development of a child?
- Detailed developmental assessment
- Take thorough history from parents
- Watch them play in clinic room with toys
- Griffith’s developmental scores
What do you look for when looking for causes of developmental delay?
- Chromosomes eg. down syndrome
- Genetic referral
- MRI brain
- Audiology - correct w hearing aids/implants
- Opthalmology
- Thyroid function
