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Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D.

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Presentation on theme: "Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D."— Presentation transcript:

1 Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D.

2 Why Learn Development?  Knowledge about Development is necessary for Assessment Goal Setting Treatment Strategy Choices

3 Assessment  Differential Diagnosis: Differential Diagnosis is all the possible causes of a set of symptoms

4 Differential Diagnosis  A Differential Diagnosis of Fever: Flu Appendicitis Diurnal temperature variation Malaria Malingering Bladder infection Alien possession Just exercised  (Partial List)

5 Assessment  When presented with a symptom a clinician has to determine which of the many possible causative factors are involved in the symptom in front of them now  Effective treatments for different causes are often different.

6 Why Learn Development: Examples  Assessment: Marc, a 6 year old boy is brought for assessment of possible impulsive behavior, not following commands, and kissing peers. He has been held back a year in school for problems with reading and math. He is a behavioral problem for everyone. He is very active compared to age peers. He speaks in 3 word sentences. He needs supervision to dress and can’t button up. He just started riding a tricycle. He can copy a circle but not a cross.

7 Differential Diagnosis: (partial list)  Attention Deficit Disorder  Conduct Disorder  Mental Retardation

8 Assessment  This copy of the Denver Developmental Screen Exam may help you with Marc’s Assessment.


10 Marc 6 year old boy Boys FunctionMental Age (years) Personal- Social Needs supervision to dress Can’t button self 3 Fine Motor- Adaptive Copy Circle Not Copy Cross 3 Language 3-word sentences No reading/letters 3 Gross Motor Pedals tricycle 3


12 Assessment  IQ = 100 x Mental Age / Chronologic Age  IQ = 100 x 3 yrs / 6 yrs  IQ = 50

13 Assessment  A knowledge of development allows us to diagnose Marc as probably having mental retardation.  Social development is consistent with mental age. Marc’s behavior is similar to other 3-year-olds.

14 Why Learn Development?  Knowledge of development helps with Goal Setting

15 Goal Setting  Teaching “Following Commands” Marc stops an activity when told “No”. Marc will not make his bed independently. Marc can spend 5 minutes learning new material. He can enjoy familiar material for about ½ hour. Marc cannot read the clock. He knows “Day”, “Night”, “School time”, “Lunch time”, “Bedtime”, and “Suppertime”.

16 Cartoon - Real Life Adventures

17 Goal Setting  Parents want Marc to learn to do chores and be responsible.  They want him to learn to change his bed because he wets his bed  Behavior Program: Marc can earn a star at lunch time if he puts his dirty PJ’s down the chute, the dirty sheets down the chute and if he puts the new sheet on the bed. Mom has demonstrated this skill  Will this behavior program work?

18 Goal Setting No  Time between activity and reward too long  Activity has too many separate parts for a 3-year-old to remember  Activity requires fine motor skills too advanced.  Activity requires more strength than Marc has  Marc has button PJ’s. He can’t manage buttons yet.

19 Cartoon

20 Goal Setting  A knowledge of Development would suggest more developmental age- appropriate responsible tasks. Clearing dishes from the table to the counter top. Emptying small waste baskets Wiping the sink after he brushes his teeth Putting cans in recycling.

21 Goal Setting  Rewards should occur soon (5 min) after Task Completion. “Thanks, Marc! You were a big help.” “We have our chores done. Let’s color.”

22 Development: Treatment Strategy Choices  Marc’s bedwetting is truly a problem for the parents. They want him to stop.  Is this possible given Marc’s mental age?

23 Rx Strategy Choices  Development – Bedwetting  Gesell: Elimination—Developmental Sequences = 36 months. Responds to routine times Goes by self - during day, but announces May hold of too long, dancing up and down, may accidentally wet Needs help with buttons Attempts to wipe self, not too successful Median age 42 months – dry at night  This means a significant minority of children are not toilet trained at night at 42 months.

24 Rx Strategy Choices  Knowledge of Development suggests that it may be Normal developmentally for Marc to still wet at night. His chronologic age is 6-years. His mental + social age is 3-years.  What are the best treatment choices?  The parents need relief. The parents will benefit from developmental education.

25 Knowledge of Development  Knowledge of Development helps with Treatment Strategy Choices  Treatment can be based on: Environmental modification Prevention Positive Reinforcement Negative Reinforcement Punishment

26 Cartoon

27 Rx Choices  Knowledge of Development helps with Strategy Choices Environmental Modification: Yes – use chucks, pull up big boy diapers Prevention: Yes – limit drinking after suppertime. AM bath to clean up Positive Reinforcement: Yes – throwing away wet chuck or diaper inappropriately. Negative Reinforcement: Maybe – if discards chuck or diaper inappropriately. Has to go back and do appropriately.

28 Behavior Management  These Behavior Management Strategies need to be used to teach desirable behaviors in successive approximations.

29 Rx Choices  Punishment: May make things worse – Child frightened  more wetting, trouble sleeping. Child angry and less compliant, more distant

30 Cartoon - P.S. Mueller

31 Why Learn Development: Summary  Knowledge of Development is necessary for: Assessment Goal Setting Treatment Strategy Choices

32 Don Anderson’s Note  Understanding normal or typical development is the primary foundation prior to the study of developmental disabilities and atypical or varied course in development.

33 Normal Development: Childhood  Developmental Lines: Definition  An skill that can be observed and assessed from birth to death, that involves one functional area. The acquisition of skills is an orderly process, succeeding skills based on earlier skills in that functional area.

34 Normal Development: Childhood  Examples of Developmental Lines Motor skills, gross and fine Perceptual skills Impulse Control Cognitive Skills Play skills Social Relations/ Attachment Speech and Language

35 Normal Development: Infancy  Babies are born with a set of skills Reflexes Readiness to  Orient to voice  Orient to caretaker  Self-management skills

36 Normal Development: Infancy  Self Management Skills  Described by T. Berry Brazelton, M.D. who developed a neonatal development assessment scale based on these items.  Sharing the results of this assessment with caretakers gave the parents more self confidence and effectiveness in dealing with the infancy period of development.

37 Normal Development: Infancy  Temperament: Definition  The set of innate tendencies, or dispositions, that underlie and affect each person’s interactions with people, situations and events

38 Normal Development: Infancy Temperamental Characteristics  Activity Level  Rhythmicity  Approach –withdrawal  Adaptability  Intensity of reaction  Threshold of responsiveness  Quality of mood  Distractibility  Attention span

39 Normal Development: Infancy Tasks of the Infant Period  Tasks of the infant period Feeding/Elimination State-Regulation Learning about the perceptual and sensory Learning early motor skills Attachment Early logic Language readiness and imitation skills

40 Normal Development: Infancy Attachment  Attachment  Reciprocal interaction in the mother child relationship in infancy.  Research done by T. Berry Brazelton

41 Normal Development: Infancy Communication  Talking with the eyes: Social referencing Drawing adult’s attention to object of interest Negation Emotional expression

42 Normal Development: Infancy  By 4 months of age  A mother can distinguish the meaning of the baby’s different cries  The baby can wait to feed, if mother says “coming, baby”.

43 Normal Development: Childhood Piaget’s Periods of Cognitive Development  0-2yrs: Sensorimotor  2-6yrs: Preoperational  7-11yrs: Concrete operational  12yrs-adult: Formal operational  Some adults age varies: Post operational

44 Normal Development: Childhood  Play as an exemplar of Piagetian theory

45 Normal Development: Childhood  Gender Identity exploration reflects Piagetian Cognitive Development

46 Normal Development: Childhood  Language and symbol formation  Truckness Suck the truck Bang the truck Roll the truck on fabric and spin the wheels Watch a real truck outside and hold up the little truck and say ”truck”

47 Normal Development: Childhood  Attachment and Piaget contribute to conscience development

48 Normal Development: Childhood  Socialization at different ages

49 Normal Development: Childhood  Autism and atypical developmental course

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