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  • Childhood development – progressive acquisition of skills as child grows and matures.
  • Complex process – series of spurts and plateaus (nothing, nothing, nothing, then a spurt of skills)
  • Affected by child related factors and environmental factors
    • Trisomy 21 - acquire skills at a slower rate
  • Wide range of normal development.

Illingworth's ideas about development

  • Development is a continuous process
  • Sequence of development same in all but rate varies (e.g. will learn to sit before they walk)
  • Development related to maturation of nervous system (but also need practice)
  • Generalised activity replaced by specific individual responses (arms moving randomly first, then they become specific and able to reach out for things purposefully)
  • Primitive reflexes lost before corresponding voluntary movement acquired
    • E.g. tonic neck reflex (look to one side and the other arm flexes up and the same side arm extends)

Various notes:

  • Hearing loss - babble up until 6 months, then, because they're getting no feedback, they become silent
  • If a child isn't walking at 20 months, that's a delay. If a child isn't walking at exactly normal time, it might not be a delay
  • Understanding normal childhood development is the the paediatrician what anatomy is to the surgeon

Theories of development

Nature vs nurture

  • Nature: Development follows a pre-programmed pattern of sequence and timing, and is only marginally affected by external stimuli.
  • Nurture: Although an intact neurobiological substrate is necessary, environmental influences play the major role in development, and outcomes will be determined by the quality and type of early interaction and stimuli.

Present state of play, based on research

  • Development is a continual process of interaction between genetically determined substrates and sequences , and the environment in which they take place .
  • Development may be influenced both adversely and advantageously by environmental factors, though degree , nature and duration of change may ultimately be determined by biological factors.
  • Both nature and nurture are important

Domains of development

  • GROSS MOTOR : POSTURE AND MOVEMENT (sitting, standing, balance)
  • FINE MOTOR : MANIPULATION (grasping with pincer grip etc)
  • SPEECH / LANGUAGE (comprehension, expressive language - written, spoken, signed)
    • 0-12 months: pre-speech (visual cues etc)
    • 9-18 months: first words
    • 18-30 months: first sentences
    • Number of syllables they should be able to say - twice their age
  • COGNITIVE
    • Practical reasoning - doing puzzles, understanding concepts
  • PERSONAL SOCIAL (social - eye contact etc)
    • Best friends, special friends
  • SELF - HELP, INDEPENDENCE

Developmental milestones

  • Milestones are particular behaviours or skills that the child has attained.
  • The age at which the child attains a milestone is compared to the normal range .
    • 15 months talking = in normal range. 22 months talking = outside normal range.
  • Determine whether development is normal or there are concerns.

Sequence of developmental assessment

  1. HISTORY -TAKING
  2. OBSERVATION OF SPONTANEOUS PLAY
  3. PRESENT NON- VERBAL TASKS
    • blocks building
    • formboards (puzzles)
    • drawing etc
  4. VERBAL TASKS
    • receptive
    • expressive
    • N.B. PRESENT SIMPLER TASKS FIRST
  5. GROSS MOTOR TASKS
  6. RETURN TO SPONTANEOUS PLAY

Assessment of development

  • Observation of the child
  • Detailed history –open ended questions then specific
    • Don't ask a closed question because parents just say yes to everything (even if you ask about ridiculously difficult tasks). You need the response to be self generated
  • Physical examination – neurological
  • Hearing – language
  • Vision – fine and gross motor
  • Developmental screening / assessment

Screening tests for development

  • PARENT’S EVALUATION of DEVELOPMENTAL STATUS (PEDS)
  • AUSTRALIAN DEVELOPMENTAL SCREENING TEST (ADST)
  • AGES AND STAGES QUESTIONNAIRES (ASQ)
  • BRIGANCE SCREENS
  • DENVER 2

Methods of assessment

  • OBSERVATION OF SPONTANEOUS PLAY.
  • DEVELOPMENTAL SCREENING
    • PEDS , ASQ
    • Australian DST
    • Others e.g Brigance
  • STANDARDIZED DEVELOPMENTAL TESTS.
    • Griffiths Mental Developmental Test (up until 4 years old or equivalent mental state)
    • Bayley Scales of Infant Development
    • I.Q. TESTS

Running through the PDF

(Just memorise the table on the pdf)

  • Mouthing is fine up until 15 months
  • From 6 weeks of age - resolution of primitive reflexes
  • 2 months: Socialise. Quieten and listen when you talk to them. Use eye contact and visual cues to "talk" to mum
  • 3 months old: can lift head and front of chest
    • Lying on stomach - at 3 months, should lift head up when put on stomach
    • If you sit them up, they have good control of head
    • Back is still rounded when sitting up
    • Hold a rattle in their hand (grasp reflex)
    • Laugh out loud (look for sound by moving eyes but not head)
    • Make a cooing vowel sound
    • Be friendly with everyone
    • Enjoy a bath
    • Express emotions
    • Generalised movements
  • 6 months
    • Firm, straight back when sitting. Arms are out for support, but don't put the arms down when falling.
    • Can roll front to back
    • Supine - can lift head, chest, and extend their arms to push up
    • Start of crawling
    • Starting to reach out to toys to grasp them - can transfer toys from one hand to the other
    • Babble lots of strings
    • Use different tones, listen for sounds, look right-left
    • More selective with people they know/recognise
    • Can feed themselves with biscuits
    • Stretch
    • Still coarse movements
  • 9 months
    • Can sit well, lateral propping
    • Might start to crawl (7-12 months)
    • Pull themselves up to stand (don't have tablecloths)
      • Won't bring bottom under their back to stand yet
    • Isolate index finger from the rest of their fingers to poke at something
    • Develops object permanence
    • Echo what the parents say (Mumma, Dadda)
    • Mouthing - everything goes to the mouth
    • Single word babble (bab bab bab!!!)
    • "Mummy put the radio on" - kid looks up to the radio
  • 12 months
    • Standing, some begin to walk alone
    • Fine pincer, hold pencil as though they can write
    • Recognise their name, turn when someone talks to them
    • String together sounds like a sentence
    • Understand what a brush/telephone is for (understand uses)
    • Affectionate to people, start to play games
  • 15 months
    • Walk alone - with wide base gate, hands out, need a lot of support
    • Can crawl upstairs
    • Can push a trolly
    • Tower building - fine motor (not lego, small blocks) - tower of 2 (14 months)
      • Tower of 4 at 18 months
      • Tower of 6-7 (2 years)
      • Tower of 8-9 (3 years)
    • Able to mark paper with linear scribble (start with dots, then back and forth)
    • Point at things at a distance (to declare something). When they get a little older, they reference back to their parents (failing to declare to parents --> autism; autistic people will just pull the parents to what they want them to see)
    • 3-4 meaningful words (e.g. Dadda first means any male, after a while Dadda just means Dad)
    • Messy spoon feeding themselves (can finger feed)
    • Help with dressing
    • Explore environment but keep mum in view (it's not normal for children to run off without their parents)
    • Can walk/move around very well
  • 18 months
    • Can walk upstairs in an adult fashion (first walk by putting one foot on a step then the other one joining)
    • Can pull a toy on a string
    • Can stoop down (without putting hand on the ground)
    • Can trot (drunken sailor, side-to-side wobble, not a run)
    • Tower of 3
    • Powerful scribble
    • May have single hand dominance (should not happen in under 12 months of age -- this can mean the other hand is weak - cerebral palsy. It's not that one hand is strong, but that the other is weak)
    • Have about 50 words (e.g. feed me)
    • Pointing out body parts
  • 2 years
    • Go upstairs alone
    • Can walk backwards (balance thing)
    • Run
    • Can kick a ball
    • Tower of 6-7
    • Imitate a train without the engine (at 2.5, they do train with the engine)
    • Circular, continuous scribble, vertical stroke
    • Can unscrew things
    • Can ask for common things by name
    • Point to body parts
    • Can form single sentences (50-200 words)
    • Can follow instructions with 2 key words
    • Can take of shoes and socks
    • Active symbolic play
  • 2.5 years
    • Can jump (first not with 2 feet together)
    • Tower of 8
    • Imitate train with engine
    • Vertical/horizontal strokes
    • Single hand dominance
    • Four/five syllables
    • Know first name
    • Can answer simple questions
    • Speech is still hard to understand
  • 4.5 years
    • Thinking outside the box
    • Easier to understand speech
    • Moving around, changing directions
    • Using hand gestures to speak
    • Joining words between sentences
  • See the table.

Later things

  • 3 block bridge at 3 years old - this is a really important marker (put a pencil in the hole to show there is a gap)
  • 6 block stairs at 3 years as well
  • "Where, what, why"
  • Stage 1 man drawing (jellyfish man - everything comes out of the head).
  • 6 block bridge (4 years)
  • 10 block stairs (6 years)
  • Stage 2 man drawing (has a body, with arms and legs coming out of it)