Development Short Cases- Approach

Ranjini S.Sivanesom

IPHKL

30.08.14

Child Development

Child development is a dynamic

process

Normal development is determined by

a complex interplay between

environmental factors, genetic factors

and acquired pathology.

Warning Signs of Abnormal

Development

Echolalia- repetitive imitation of

speech- still present by 3 years.

Absoulte failure to develop skills (eg

multi- syllable babble with intonation-

by 10 months)

Motor asymmetry

Developmental regression- loss/

plateauing of skills

The Developmental Examination

History taking: family history, social and

family environment, pre-, peri- and

postnatal history.

Enquire into the parents concerns and seek

information from others who know the child

(eg. teachers, health- care staff)

Observation and interactive

assessment

Suitable selection of toys should be

made available before meeting the

family and interacting with the child.

Appropriate toys for the age of the

child and the domains of development

to be assessed.

Observation and interactive

assessment

Examples:

Copying behaviour (bell) and understanding of

cause and effect (pop- up animal toys)

Definition by use (cup/ spoon, doll/ brush) and

symbolic understanding (doll/ teddy/ tea set)

Fine motor/ eye- hand (bricks, crayons/pencil/paper,

soft ball, form boards, puzzles)

Language and play (books with single pictures and

stories, range of everyday toy objects, large and

miniature toys)

Observation and interactive

assessment

‘Free Play’- the child’s inability to organize the environment and generate ideas on their own will be significant.

Eg. May not be able to focus attention (flit from one object to another or repetitive play may be noted.

Cardinal rule of DA: to look not only what the child does, but also how s/he does it.

Quality of response should therefore be monitored as well as the actual achievement.

2014/9/5

2014/9/5

Developmental Examination: Birth to

1 Year

Gross motor

Fine motor

Speech language communication

Social

Cognitive

2014/9/5

Developmental Examination: Birth to

1 Year

Motor Development

Tone, movements and posture (eg head

control, hands (open or fisted), spine

curvature, legs posture, weight bearing) in

supine, pull to sit, supported/ independent

sitting and standing, ventral suspension and

prone position (180* manoeuvre).

Examine primary (Moro, grasp and ATNR)

reflexes

2014/9/5

Developmental Examination: Birth to

1 Year

Significant Delay Age

Fisting of hands > 3/12

Poor head control 4/12

Persistence of primitive

reflexes

> 6/12

Persistence of flexor

hypertonia in the LLs (popliteal

angle < 150*)

> 9/12

Unable to sit independently

with straight spine

10/12

Not walking 18/12

2014/9/5

Developmental Examination: Birth to

1 Year

Fine Motor Development

Coordination of vision with head movement (6- 8 weeks) and

hand movements - watches own hand (hand regard) or

objects held in hands (3- 4 months)

Two- handed reach replaced by single- handed reach (5- 6

months)

Exploration with index finger (8- 9 months)

Maturing grasp: improving apposition of tips of fingers with

the tip of the thumb (palmar- 6/12, pincer (thumb- finger)- 9 to

10 months and finger tips (12 months)

Release with open hands or with pressure (10 to 11 months);

controlled release - puts one cube on top of another (13

months)

2014/9/5

Developmental Examination: Birth to

1 Year FINE MOTOR DEVELOPMENT

Coordination of vision with head movement

and hand movements - watches own hand

(hand regard) or objects held in hands

6- 8 weeks

3- 4 months

Two- handed reach replaced by single-

handed reach 5- 6 months

Exploration with index finger 8- 9 months

Maturing grasp: improving apposition of

tips of fingers with the tip of the thumb

(palmar)

- pincer (thumb- finger)

- finger tips

6 months

9- 10 months

12 months

Release with open hands or with pressure

- controlled release - puts one cube on top of

another

10- 11 months

13 months

2014/9/5

Development of Grasp: Cube

2014/9/5

Developmental Examination: Birth to

1 Year

Speech,

language and

communication

Common objects

or large toys eg

a ball, cup, plate,

spoon, car or doll

2014/9/5

Developmental Examination: Birth to

1 Year

Observation of language development: Birth to 1 year

2014/9/5

Developmental Examination: Birth to

1 Year

Observation of language development: Birth to 1 year

2014/9/5

Developmental Examination: Birth to

1 Year

Non- verbal communication

Vocalisation- 3/12

Pointing to ask - 9/12

Pointing to show- (9- 12 months)

Proto- imperative pointing (12 months)

Proto- declarative pointing (16 months)

Conventional gestures eg waving

goodbye,blowing a kiss - (9- 12 months)

2014/9/5

Developmental Examination: Birth to

1 Year

Social Development

Social responsiveness and anticipation

Social smile (6- 8 weeks)

Responds to social games eg peek-a-boo and shows anticipation (6 months)

Developing joint attention

Follows other's finger point to look at an object (8 months)

Uses finger and eye pointing to direct others' attention to share interest (9- 12 months)

2014/9/5

Developmental Examination: Birth to

1 Year

Social Development

Becoming stranger aware- reacting by

withdrawing or crying (6 months)

Social referencing - checking back by

looking towards the caregiver in new

situations (12 months)

2014/9/5

Developmental Examination: Birth to

1 Year

Cognitive Development

Observation of infant's cognitive abilities are

made during fine motor, communication,

play and social interaction activities

4 main structured tasks are used

2014/9/5

Developmental Examination: Birth to

1 Year

1. Physical rules and object relationships

Offer 1 cube:reach, grasp, exploration, hand-to-hand transfer (reach out to grasp:5/12)

Offer another cube: imitation of clicking of two cubes (6/12)

Request for a cube back by putting open hand out- note release

Put an open container and encourage releasing a cube into it and taking it out (9- 15 months)

Inserting pegs into holes (15 months)

2014/9/5

Inserting Pegs into Holes

(15 months)

2014/9/5

Developmental Examination:

Birth to 1 Year

2. Cause- and- effect understanding and goal directed actions

Pop up or other action toys

Place a toy out of reach and the connected string near the child. Check grasp of string and pulling the string to get the toy

Shake a bell - 7/12, using cause-and-effect toys- 9/12, pulling a toy with a string- 9/12, moving a car- 12 months

Significant delay: No cause-and-effect play by 12 months

2014/9/5

2014/9/5

Developmental Examination: Birth to

1 Year

3. Object permanence: Finding a hidden

toy (partially/ completely covered with a

cloth)

Look for a partially hidden object: 6- 8

months

Search for a toy which has been completely

hidden in their view: 9- 10 months

2014/9/5

Object Permanence(9- 10

months)

2014/9/5

Developmental Examination: Birth to

1 Year

4. Categorisation

Use common objects/ toys: a toy, car,cup,spoon, bell, telephone (on self/ doll/ mother)

10-12 months: infants use similar looking objects/ toys in the same way eg moving toys that look like a vehicle

14 months: show 'definition by use' eg using a hair brush to brush their hair

Significant delay: not defining objects by their use by 18 months

2014/9/5

Categorisation: Common Toys

2014/9/5

Non- verbal perceptual-cognitive

development

5. Drawing

Scribble to and fro: 15- 18 months

Circular scribble: 2 years

Draw a man

Copy shapes

Grasp of crayon/ pencil: 3years (50%) -

4 years (80%)

Handedness: appears from 2- 4 years.

Appearance before 12 months, prompt

neurological examination

2014/9/5

Developmental Examination: 1- 5

years

1. Motor development

2. Non- verbal perceptual- cognitive

development

3. Speech, language and communication

2014/9/5

Non- verbal perceptual-cognitive

development

1. Block (1- inch cube) construction tasks

Imitate a model (child is shown how to do it)

Copy a model (child is shown a completed

model)

2014/9/5

Non- verbal skills tasks,1- 5 years

2014/9/5

Non- verbal perceptual-cognitive

development

2. Shape sorting/ jig-saw puzzles/ form

boards

30months: Match 3 basic geometric shapes

(circle, triangle and square) even when the

form board is reversed

2014/9/5

Form board with basic geometric

shapes (30 months)

2014/9/5

Non- verbal perceptual-cognitive

development

3. Colour matching

and naming

30 months: 50% of children can match cubes/ cards by colour

42- 48 months: name 4 colours correctly

2014/9/5

Non- verbal perceptual-cognitive

development

4. Sorting objects

by size

3years: point to big/ small

cube/spoon/cup

42- 54 months: point to a

long/ short line drawn on a paper

2014/9/5

Crayon or Pencil Grasp

Palmar- Supinate Grasp

1- 11/2 years Digital- Pronate Grasp

2- 3 years

Static Tripod Posture

31/2 - 4 years

Dynamic Tripod Posture

41/2- 6 years

2014/9/5

Goodenough Draw- A- Person Test

Gross detail

Attachments

Head detail

Clothing

Hand detail

Joints Proportion

Motor Coordination

Fine head detail

Profile

Visual Behaviour, eye- hand

coordination and problem solving

Progressive coordination of maturing vision with head, body and fine motor movements can be observed through: manipulation and use of pellet, rings, bell, cubes, crayon/ pencil, form boards or puzzles.

Achievement in this domain represent the precursor to later non- verbal problem solving abilities, correlate well with intellectual ability and may provide early markers for learning, psychological and psychiatric disorders.

Co-ordinated eye movements and

eye-head co-ordination

Earliest developmental sequence starts with

fixing gaze on the mother’s face

following a face with eyes only co-

ordinate eye- head movements to turn head

to follow visually

Any abnormality of early visual behaviour

should prompt referral for ophthalmological

assessment

Eye- head co-ordinated milestones

Developmental milestones Mean age Limit age

(months) (months)

Visually alert, orients to face 1 Any delay

Visually follows face 2 Any delay

Co-ordinates eye movements with 3 Any delay

head turning

Eye- hand co-ordination

The infant shows visual awareness of

hands and becomes increasingly refined in

combining vision with hand movements for

reaching, grasping, exploring and releasing

objects.

Eye- hand co-ordination milestones

Developmental milestones Mean age (months)

Holds objects briefly when placed in hands 3

without visual regard

Visually examines own hand 4

Reaches out with a two- handed scoop 5

Reaches out and grasps objects on table surface with a 6

raking grasp

Transfers from hand to hand 6

Explores with index finger 6

Picks up a pellet/ raisin between thumb and finger 9

Eye- hand co-ordination milestones

Developmental milestones Mean age (months)

Picks up a string between thumb and finger 10

Can release in a container 10

Has mature grasp 12

Has precise release- without pressing on surface 13

Builds tower of 2 cubes 13

Builds tower of 3 cubes 16

Turns pages of book one page at a time 24

Language and communication

milestones Developmental milestone Mean age Range

(months) (months)

Comprehension/ receptive language

Understands ‘no’/’bye’ 7 6- 9

Recognizes own name 8 6- 10

Understands familiar names 12 10- 15

Definition by use: using objects by 15

Giving objects on request by 15

Points to body parts on self/ carer 15 12- 18

Points to body parts on doll 18 15- 21

Identifying objects on naming by 24

Follows a 2- step command 24 18- 27

Understands preposition (in/on) 24 18- 33

Understands preposition (under) 30 24- 39

Understands action words by 36

(eg. eating/ sleeping)

Understands simple negatives 36 30- 42

Understands comparative 42 36- 48

Follows 2 instructions 42 36- 48

Understands complex negatives 48 42- 60

Follows 3 instructions 54 48- 66

Language and communication

milestones Developmental milestone Mean age Range

(months) (months)

Expressive language and non- verbal communication

Jargon 12 10 – 15

Syllabic and tuneful babble 8 6- 9

Pointing to demand 9

Pointing to share interest 10 9- 14

One word 12 10 – 18

2- 6 words 15 12- 21

7- 20 words 21 18- 24

50+ words 24 18 – 27

2 words joining 24 18- 30

200+ words 30 24- 36

3- 4 words joining 30 25- 36

Pronouns 42 36- 48

Uses conjunctions (and, but) 48 36- 54

Sentences of 5+ words 48 36- 54

Complex explanations and sequences 54 48- 66

2014/9/5

Speech, language and

communication

1. Comprehension

2. Expression

3. Speech sound and fluency: intelligible

speech 2 years (50%), fully intelligible by 4

years

4. Pragmatics:21/2 - 3 years take turns in

conversation, 4 years hold conversation skilfully

2014/9/5

Speech, language and

communication

Place some toys/

objects (eg a cup,

spoon, plate, 1

inch cubes, key,

fork, pencil, car,

miniature toys and

pictures for 24

months and

above) near the child

and ask questions

2014/9/5

Step 1

Comprehension

Object labels (15- 18 months): 'look at the....', 'where is the....', 'give me the...."

Identify by use (24- 30 months):

'which one do we eat with/ drink with/ sleep in?' (avoid pointing by finger or looking at the objects while asking)

Expression

Object labels (18- 20 months): 'What is this one', 'this is a ...."

2014/9/5

Step 2

Comprehension (30

months)

Ask without pointing:

'show me who is

eating/ sleeping/

running'

Expression (30- 36

months)

Ask while pointing at a

picture: 'What is the

boy/ girl doing)'

2014/9/5

Step 3

Comprehension

Preposition (24- 36 months)

Colour (identify or name 2 colours by 36 months and four by 48

months)

Size: identify size (bigger/ smaller) of an object or picture (36

months), a longer line (42 months), the weight (heavier of cubes, 48

months)

Numbers: rote counting as a nursery rhyme (3 years), 31/2 - 4

years - count four to six cubes/ objects correctly, 4- 41/2 years- can

follow direction to 'put three cubes in the cup'

4+ keyword sentences (42 months): give direction in a single

sentence eg 'put the big cube and the spoon in the box'

Joined up sentences (48 months):'Put the spoon in the box and the

pencil on the plate'

2014/9/5

Step 3

Expression Have a conversation with the child: school/

playtime

Look at the picture and tell me what is happening (describing narrative: 41/2- 5 years)

Describe common objects/ concepts:'What is a key/ friend?' (defining words: 52 months)

Play and social behaviour

Observation of play offers a unique

opportunity to look at a number of

developmental sequences as they

come together to create an

increasingly complex tapestry of play.

Developmental sequences involved

in play

Cognitive play sequence

9 months

Object oriented

exploration play

(maturing eye- hand co-

ordination and object

concepts)

18 months

Functional use of real

objects on self and

others (eg. spoon,

brush)

24- 30 months

Symbolic use of toys

(eg. Toy, tea set, doll)

3- 4 years

Pretend or imaginative

play

Developmental sequences involved

in play

Social play sequence

4- 5 weeks

Social smile

(90% by 6 weeks)

6- 12 months

Social anticipation

Lap games

(eg. peek- a- boo, pat- a

cake)

10- 15 months

Joint attention

Points to show

3- 3.5 years

Social imitative play

(eg. role play)

Classification of Play Actions into the Five

Stages

Stage I

Exploratory

Play

Stage 2

Relational Play

Stage 3

Self

Pretending

Stage 4

Decentered

Pretending

Stage 5

Sequence

Pretending

By physical By usage

Properties

Doll+ object Doll

alone

Same action Theme

Mouthing Banging two Spoon

Objects in cup

Feeds self with spoon/cup Feeds doll with Hugs

spoon/ cup doll

Feeds doll Sleep

-self sequence

-adult

Shaking/ Hitting Placing objects Pillow

into another on bed

Combs hair Combs doll’s Kisses

Hair doll

Pillow

on bed

Doll on

bed –

head on

pillow

Examining Placing objects ‘Sheet on’ bed/

on top of table

another

Washes self Washes doll Walks

doll

Combs doll Covers

-self doll

-adult with

sheet

Dropping/ Throwing Chair to table Sleeps on doll’s bed or

pillow

Lies doll Makes

on pillow/ doll

Bed jump

Feeling/ Rubbing Sits on doll’s chair

Dresses self with

doll’s clothes

Sits doll on -dance

Chair -somersault

Dresses/ undresses

doll

Puts doll Feeding

on bed Bathing

Child ‘sleeps’

Gestures adult to sleep

Tools

Minitiature toys: Wood table, small spoon (spoon of

different sizes), doll, bathtub, 1 aeroplane (small

red one), 1 teapot with cover, 1 jug, 1 bowl, 1 small

dog/ cat/ cow, 1 car, 2 cups and 2 saucers, 2 chairs

(different colours eg white and red of same size).

1 plastic cup, teaspoon, brush, comb, shoe, sock

( 5 items to check on language)

Dangling ball (wooly 12.5cm, plastic 6.25cm)

Small targets (cube 2.25cm, smartie 1.25cm, HT

1.25mm)

Gross motor

Delay in achievement of the gross motor

milestones may be an indicator of

neurological abnormalities and is

sometimes associated with a global

developmental delay.

Development of attention

Stage I- extreme distractibility. Attention shifts from

one object/ person/ event to another. Their

attention is held momentarily by whatever is the

dominant stimulus (Year 1)

Stage 2- children can concentrate on a task of their

own choice. They are v. resistant to interference by

an adult (Year 2)

Stage 3- can shift their full attention to speaker and

back to task with adult support. (Year 3: ‘single-

chained attention’)

Development of attention

Stage 4- Children begin to become able to control focus of attention. Looks at an adult only when the directions become difficult to understand (Year 4: early ‘integrated attention’)

Stage 5- Can integrate verbal

commands related to a task. Attention span still short. (Year 5: mature ‘integrated attention’)

Development of attention

Stage 6- Fully integrated attention. Auditory,

visual and physical channels are integrated.

Attention is well established.(5- 6 years)

2014/9/5

2014/9/5

2014/9/5

2014/9/5

2014/9/5

C:\Users\username\Desktop\IMG_2115.

MOV

2014/9/5

C:\Users\username\Desktop\Dropbox.lnk

2014/9/5

C:\Users\username\Desktop\IMG_2

122.MOV

2014/9/5

C:\Users\username\Desktop\IMG_2120.

MOV

2014/9/5

C:\Users\username\Desktop\IMG_2123.

MOV

Thank You