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Flashcards in Development Deck (85)
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1
Q

Medical/Biological Neonatal Risk Criteria for Developmental Delay
7

A

Birth weight less than 1501 grams
Gestational age less than 35 weeks
Central nervous system insult or abnormality (including neonatal seizures intracranial hemorrhage, need for ventilator support for more than 48 hours, birth trauma)
Congenital malformations
Asphyxia (Apgar score of three or less at five minutes)
Abnormalities in muscle tone, such as hyper- or hypotonicity
Hyperbilirubinemia (> 20 mg/dl)

2
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 2
(5)

A

Hypoglycemia (serum glucose under 20
mg/dl)

Growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem)

Presence of Inborn Metabolic Disorder (IMD)

Perinatally- or Congenitally transmitted infection (e.g., HIV, hepatitis B, syphilis)

10 or more days hospitalization in a Neonatal Intensive Care Unit (NICU)

3
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY (3)
(6)

A

Maternal prenatal alcohol abuse
 Maternal prenatal abuse of illicit substances
 Prenatal exposure to therapeutic drugs with known potential development implications (e.g., psychotropic medications, anticonvulsant, antineoplastic)
 Maternal PKU
 Suspected hearing impairment (e.g., familial history of hearing impairment or loss; suspicion based on gross screening measures)
 Suspected vision impairment (suspicion based on gross screening measures).

4
Q

MEDICAL/BIOLOGICAL NEONATAL
RISK CRITERIA FOR
DEVELOPMENTAL DELAY 4
(6)

A

 Parental or caregiver concern about developmental status
 Suspect score on standardized developmental or sensory screening test
 Serious illness or traumatic injury with implications
for central nervous system development and requiring hospitalization in a pediatric intensive care unit for ten or more days
 Elevated venous blood lead levels (above 19 mcg/dl)
 Growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia)
 Chronicity of serous otitis media (continuous for a minimum of three months)

5
Q

Other Risk Criteria to make a referral***

8

A

 No prenatal care
 Parental developmental disability or diagnosed serious and persistent mental illness
 Parental substance abuse, including alcohol or illicit drug abuse
 No well child care by 6 months of age; or significant delay in immunizations; and/or,

History of child abuse or neglect;
Concern re: parenting due to poor bonding;
Impairment in psychological/interpersonal functioning
Homelessness or dislocated housing status.

6
Q

Freud Oral – Birth to 18 months

3

A

Mouth is primary body zone
Sucking and eating
Major conflict weaning
Interpersonal focus on self with little differentiation from others

7
Q

Freud Anal – 18 months to 3 years

4

A
  • Anus is primary body zone
  • Major conflict: toileting
  • Major activities toilet training
  • Interpersonal focus is rebellion vs. compliance with parents wishes
8
Q

Freud Phallic – 3-6 years

4

A
  • Genital area is primary body zone
  • Genital exploration and fantasy are major activities

• Major conflict = Oedipal complex
((psychoanalytic theory, a desire for sexual involvement with the parent of the opposite sex and a concomitant sense of rivalry with the parent of the same sex))

• Attraction to opposite sex parent and Identification with same sex parents as major interpersonal focus

9
Q

Freud – Latency 6-11 years

4

A
  • No primary body zone
  • Social relationships are very important** mastery over impulses
  • No major conflict
  • Identification with same sex peers and powerful heroes
10
Q

Freud: 11-18 years

Genital (4)

A

Primary body zone: genital

Sexual maturity and expression are major activities

Separation from family is the major conflict

Interpersonal focus: Successful extrafamilial relationships

11
Q

Erickson

Trust vs. Mistrust (4)

A

Infancy

Develops when needs are met by a consistent loving person

Mistrust develops when needs are not consistently met

With trust, Sense of hope and optimism is outcome

12
Q

Erikson

Autonomy vs. Shame (3)

A

Toddler

Child gains control of body and wants to use power to control environment

Shame and doubt appear when child is forced to be dependent when the child can actually master control

Positive outcome = sense of self control and will-power

13
Q

Erikson

Initiative vs. Guilt (4)

A

3-5 years preschool

Child uses his/her senses and power to explore physical world and imagine a fantasy world

Conscience is acquired as child starts to listen to an inner voice

Guilt arises when child does something in conflict with goals of other

Positive outcome is direction and purpose

14
Q

Erikson

Industry vs. Inferiority (4)

A

School Age

Child start to complete activities and tasks and achieving a sense of accomplishment and mastery

Rule learner and works cooperatively and competitively with others

Inferiority comes when more is expected than the child can achieve

Sense of competence is the positive outcome

15
Q

Erikson - Identify vs. Role confusion (3)

A

Adolescent**

Preoccupied with physical appearance, how he or she is seen by others, role he/she plays and how his/her concepts and values mesh with those of peers and society

Unable to solve conflicts between concept of self and society

Positive outcome is a sense of fidelity to values and other people

16
Q

Controversies around Erikson

A

Very influential theorist of emotional development

Developmental challenges as points in which the individual must choose the more desirable emotional stance

17
Q

Noam

A

Feels early adolescence is more concerned about group cohesion and less concerned about identify

Younger adolescent are more susceptible to peer pressure

Development is not linear

18
Q

Stella Chess

A

 Easy (40%)
Regular routines, cheerful

 Difficult (10%)
Irregular, slow to accept change  Negative responder

Slow to warm (15%)
Inactive, mild low key  Slow adjustment

 Mixed (35%)

19
Q

Alexander Thomas and Stella Chess

Easy

A

 Temperament is innate

 Easy: 40% of children
• Regularity
• Positive approach
• High adaptability
• Mildly to moderately intense mood
Sleep through the night, coo etc.
  • Parent needs to spend separate time with child since he can be forgotten
  • May do what other’s wants even though no in best interest
  • Child is trusting
  • Teach child how to develop own rules
20
Q

Alexander Thomas and Stella Chess

Difficult

A
 Difficult: 10% of children
Irregularity of biological functioning
Negative withdrawal in response to new stimuli, non adaptability
Slow adaptability
Intense mood

Parent needs to be
- Firm and consistent
- Patient
- Gradual repeated reinforcement of positive and
negative for expected
- Give minimum number of rules for any one time
- Provide venue to extra emotions and energy

21
Q

Alexander Thomas and Stella Chess

Slow to warm up

A
 Slow to warm up: 
15% of children: 
- negative mood of mild intensity
- Slow adaptability to new situations
- Parent need to maintain calm as anger accelerates for child’s reaction
- Do not compete with child
- Repetition is needed
- Maintain consistent rules
22
Q

Alexander Thomas and Stella Chess

Goodness of Fit

A

 Goodness of Fit

Central is understanding how child’s temperament on
the family

Impact of temperament on child’s adaptive functioning

Child’s temperament fits with parental goals, standards, and values that affects the nature of the parent’s responses to the child.

Difference between there are differences between parental expectation and the child’s temperament “poor fit”

23
Q

Stages of Cognitive Development - Jean Piaget (First 2)

A
  1. Sensorimotor Stage:
    Birth to 2 years old
    • No thinking structures
  2. Preoperational Stage:
    2-7 years old
    • Develop language skills cognitive structures – prelogical
24
Q

Stages of Cognitive Development - Jean Piaget (Second 2)

A
3. Concrete Operational Stage:
7 years to Adolescence –
• Begins to question life.
• Solves problems but haphazardly
• Mass, number, linear time
• Deductive reasoning
  1. Formal Operations Stage:
    Adolescence and onward –
    • capable of sophisticated logical thought.
    • Can think both abstract and hypothetically
    • Solves problems using the logic of combinations
25
Q

Kohlberg
Birth to 18 months

18 Months to 9 years
Two Orientations**

A

Birth to l8 months
“Amoral”
Moral reasoning cannot begin until the child reaches a certain level of cognitive development

18 months to 9 years
Preconventional:
Obedience and punishment orientation*
• Behavioral decision made on fear of punishment
• Good and bad defined in terms of physical consequences

Instrumental Relativist Orientation (3-6 years)*
Behavioral decisions made based on concern of self and egocentric satisfaction although occasionally will do something to please another if adv. for self

26
Q

Kohlberg
Conventional Thinking
two orientations**

A

Most people remain here

Interpersonal concordance
• Moral thinking is guided by individual’s interpersonal relationships and place in society
• Behavioral decision made on what child desires
• Desires to gain approval of significant others

Law and order orientation
• Behavioral decision based on laws and respect for authority

27
Q

Kohlberg

Post-Conventional

A

Social Contract Legalistic
• Makes decisions based on personal beliefs and values
• Adolescent

Universal Ethical Principle
• Decisions made based on higher principle
• Young adult

28
Q

Key Principles (7) – 1

A

Growth and development is orderly and sequential
Each child sets their own pace
Growth is cephalocaudal
Growth is Proximodistal
Behaviors become increasing integrated
There are critical periods in development
Environmental, social, genetics, nutrition all play a role.

29
Q

Key Principles (6) – 2

A

Responses to stimuli go from generalized reflexes involving the entire body to discrete voluntary actions

Growth milestones are predictable

Language delays are the most common

Speech and language are not synonymous

Receptive and expressive language are different

Skills are built on each other and are rarely skipped

30
Q

Developmental Surveillance

A

Monitoring a child’s development over time

 Ongoing process of accessing a child’s developmental status at each well child visit
 Taking a thorough history
 Reviewing developmental milestones
 Making skilled observations of the child during the office visit
 Eliciting parental concerns

Observes the child’s rate of
 Development
 Temperament style
 Emotional adjustment

31
Q

Developmental Screening

A

Access a child’s current developmental function compared with a standardized sample of children of same age

32
Q

Purpose of Developmental Screening

A

Identify those children with delays

Do not identify children without delays

Too time consuming to perform at each visit

33
Q

Developmental Screening Tools

A

 Child development inventories

Minnesota Child Development Inventories
Ages and Stages Questionnaire (formerly infant monitoring system)
Parent’s Evaluations of Developmental Status (PEDS)

34
Q

Newborn Reflexes
Tonic Neck
Stepping and Walking

A

Tonic neck
Increased tone
Leg extension of side of head direction
Flexion in contralateral arm and leg

Stepping and walking
Range from minimal weight bearing to several brisk steps with plantar stimulation

35
Q

Moro
Age of emergence
Age of disappearance

A

Complete at 37 weeks

4 months

36
Q

Tonic Neck
Age of emergence
Age of disappearance

A

35 weeks, peaks at 4-6 weeks of life

4-6 months

37
Q

Palmar grasp
Age of emergence
Age of disappearance

A

28 weeks

3-6 months

38
Q

Placing, stepping
Age of emergence
Age of disappearance

A

37 weeks

6-8 weeks

39
Q

Ankle clonus, up to 5-10 beats
Age of emergence
Age of disappearance

A

33-35 weeks

1 month

40
Q

Pupillary response
Age of emergence
Age of disappearance

A

32 weeks

Never

41
Q

Babinski

A

Age of disappearance = + until start to walk

42
Q

Physical Growth

Head circumference

A

Length 9-11 inches first year

Head circumference
2 cm/month to 3 months
1 cm/month 4-6 months
.5 cm/month 6-12 month

43
Q

Fontanel

A

Posterior fontanel: 2 months

Anterior fontanel: 18months - 2 year

44
Q

Birth weight

A

Birth weight to 6 months: one ounce a day

6-12 months: 1⁄2 ounce per day

45
Q

Physical Growth

Birth weight by end of second year

Length

A

Birth weight quadrupled by end of 2nd year
2-9/ 5 pounds per year

Length:
• 5 inches in 2nd year
• 3-4 inches in 3rd year
• 2-3 inches per year post this
  20 teeth by 2.5 years
46
Q

4 weeks (4)

A

Lifts and turns head
Raise head momentarily to ventral
Reflex grasp
Follows with eyes to midline

47
Q

5 weeks (4)

A

Regards Face
Lifts head while prone
Equal movements of extremities
Mother responds to infant cues

48
Q

2 months (5)

A
Follows to midline
  Sustain head in ventral   
  Active grasp
  Vowel sounds--coos
  Smiles responsively
49
Q

3 months (6)

A

Raise head above ventral plane + legs extended-up to 90 degree angle
Will make hand contact and hold briefly
Some head control
Grabs rattle
Follows past midline
Stop movement, appears to listen, turn toward sound

50
Q

Red Flags at 3 months (3)

A

No social smile
Persistent fisting
Failure to alert to visual/auditory stimuli

51
Q

4 months (7)

A

No head lag
Hands in midline
Bring objects to mouth
May have bald spot on occiput due to midline position
Loud laugh
May go from laughing to crying
Follows past midline hold head to 90 degrees

52
Q

5 months (3)

A

Head erect and steady
Begin to roll over: first from prone to supine
Can be pulled to a standing position and can support wt.

53
Q

6 months (10)

A
No head lag
  Reach for an object
  Turns to voice
  Transfer hand to hand after learning grasp
  Flex knees temporarily then extend
  May sit alone, but can roll especially from prone position
  Bears some weight
  Clear preference for caregiver
  May accept strangers; cuddles
  Interested in legs and feet
54
Q

7 months (3)

A

Pursue a pellet with raking -cannot pick up
Will respond to changes in facial expressions
Pivot in prone position to go after an object

55
Q

8 months (7)

A

Go to sitting position without help with back straight
Stand if hands are held
Repetitive constants: ma-ma, baba Respond to name
Separation anxiety
Play peek-a-boo in preparation Feeds self crackers
Turns to voice

56
Q

9 months (10)

A
Sits without support, stands holding on
  Imitates speech sounds
  Creep or crawl
  May take steps with both hands held
  Poke with index finger
  Pincer motion (thumb finger grasp)
  Wave bye-bye
  Release an object by request
  Object permanence
  Become less dependent on presence of mother
57
Q

Red flags between 6-12 (4)

A

Persistence of primitive reflexes after 6 months
No babbling by 6 month
No reciprocal vocalization by 9 months
Inability to localize sound by 10 months

58
Q

12 months

7

A

TODDLER—Autonomy-vs.-Shame: doubt 12 months
Responds to no
Stand alone for 2 seconds
Rise independently and take step

Pincer without ulnar
Games with ball
Extend an object and release it into offered hand

May show by behavior knowledge of objects

59
Q

15 months (8)

A

Walks alone
Stoops to recover toy on floor

Says 1 word besides “Dada” and “Ma-ma”
Jargon

Follows 1 step command, no gesture

Put pellet into a small bottle
Put 1 cube on top of another with demonstration
Manages cup

60
Q

18 months (10)

A

Says 3 words besides “Mama”, “Dada”

Walks backwards
Imitates household chores e.g. sweeping
Up stairs one at a time with 1 hand held
20 months: go down stairs one at a time with 1 hand held

Scribbles
Dump pellet from bottle
Stacks 2 blocks

Lifts elbow

61
Q

2 years (13)

A

Gains 5-6 pounds and 5 inches
Head growth is 2cm
Kicks ball forward
Removes article of clothing (not hat) Combines two words
Mild lordosis with protuberant abdomen 8 more teeth to total 14-16
Run about stage
Tower of 7 cubes
Imitate circular strokes horizontal line Empty trash cans and drawers
Parallel play
Speech should be understood

62
Q

Red Flags – 2 years (6)

A
No consonant production by 15 months
  No words
  Hand dominance before 18 months
  Not walking by 18 months
  Inability to walk up and down stairs by 24 months
  No two word sentences by 24 months
63
Q

Red Flags in Evaluating Infant Motor Development

Motor

A

Motor
Abnormal movement patterns
• Increased tone: Spasticity
• Early rolling (1 month)
• Pulling directly to stand @ 4 months • W-sitting
• Persistent toe walking
• Hand dominance prior to 18 months • hemiparesis

64
Q

Red Flags in Evaluating Infant Motor Development

Motor Development

A
Motor Development
  No rolling to prone to supine by 7 months
  No rolling supine to prone by 9 months
  No unsupported sitting by 10 months
  No independent steps by l8 months
65
Q

Important Fine Motor Milestones

A
Tower of 8 cubes: 2.5 years
  Thumb wiggle 2.5 years
  Copies circle: 3-3.5 years
  Person with 6 parts 4.5 years
  Copies square by 5 years but can start as early as 4.5 years
66
Q

Gender Identity

A

2 year old:
Knows male or female

3-4 year
Show sex typed preference

5-6 year old
Notion of how male or female should dress

67
Q

Language Overview

A

Language is a sequential acquisition in following pattern:
Emergence of words and basic vocabulary
Transition from one word to word &
phrase combinations
Transition from single to complex sentences
Most importantly, language acquisition is influenced by biological factors as well as child’s rearing environment

68
Q

How Language Develops

Receptive vocab vs. Spoken vocab

A

Baby’s earliest communication is to attract attention from parents & others in environment

Receptive Vocabulary refers to words an individual understands & which greatly increases in second year

Spoken Vocabulary begins when infant utters its first word occurring at approximately 10 to 15 months of age

69
Q

Language

Birth to 3 months

A

Receptive: Attends to voices/sounds Prefers parental voice may orient to voice by turning eye

Expressive: Has different cries Vocalizes (coos, gurgles) Reciprocal vocalization

70
Q

Language

3 months to 6 months

A

Receptive:
Works to localize vocalization sound Enjoys toys that make noise
Responds to name at 6 month

71
Q

6-9 months

A

Receptive
Looks to family member when named Begins to understand words

Expressive
Vocal play
Babbles with a string of syllables with intonation.
Uses mama and dada nonspecific

72
Q

Language 9 months-1 year

A

Receptive
Understands verbal cues peek a boo Looks when name is called
70 words-12 months

Expressive
Uses mama and dada specific
Imitates
Waves bye bye Reaches to be picked up

73
Q

Language

12 to 15 months

A

Receptive
Follow one step direction

Expressive
Shakes head Use of 3-6 words

74
Q

Language

15-18 months

A

Receptive
Points to objects/picture 18 months

Expressive
Repeats words Says no

75
Q

Language

18-24 months

A

Receptive
Follows two step directions
Enjoys simple stories

Expressive
Language explosion Up to 50 words with average of 200 words by age 2 years
50% intelligible

76
Q

Language

24-30 months

A

Receptive
2 step directions
Able to point to different actions

Expressive
Less jargon
Simple questions
Joins in songs

77
Q

Language

30 to 36 months

A

Receptive
2-3 step directions Identifies colors

Expressive
Uses 900 to 1000 words
Speech is 75% intelligible by age 3 years

78
Q

Language

36-48 months

A

Points to objects by category

5 to 6 word sentences by age 4

79
Q

Be Suspicious

A

Developmental language disorders are not rare–> affect between 5-8% of all preschoolers.

Language disorders are so potentially disruptive and handicapping
Must be alert to the possibility in every child

If you suspect a speech/language delay or comprehension difficulty, obtain a hearing test immediately!

80
Q

Recommendations

A
  1. Screening tool
  2. Formal observation
    - Use Caution
  3. Parent interview
    - Don’t ask for recall
81
Q

When to Refer

A
When recommended by screening tool
  Delay in language development > 1 year
  Speech noticeably unintelligible
  Positive hearing loss
  Presence of an obvious medical problem
NOTE: Referral to evaluation and intervention programs (Early Intervention Program) are mandated by law!
82
Q

Where to Refer

A

Audiologist/ENT for hearing related issues
Early Intervention (children 3 yr.)
American Speech Language and Hearing Association 1-800- 498- 2071

83
Q

Other Language Concerns

A
Stuttering (repetition/pauses/eye blink)
  Preschooler (2-5 yrs.) normal   Refer
• If the child > 6yrs
• Embarrassed
• Interferes with communication • Parents very concerned
• Lasts > 6mo
84
Q

Anticipatory Guidance

A

Listen
Show enthusiasm for your child’s interests
Discuss activities while in progress
Use recasting methods
Speak slowly and clearly
Teach parent to avoid baby talk and to read at least once a day
Avoid correcting child’s language
Introduce your child to other adults and children

85
Q

PLAY

A

Solitary play: infancy
Parallel play: toddler

Preschooler:
Cooperative play
Dramatic presented play
Rough and tumble play