1. Developmental Assessment Dhaara Iyer (ST5) October 2011

2. Learning objectives What is development? What is development? What is normal/abnormal? What is normal/abnormal? How do you assess it? How do you assess it? Why do we want to know? Why do we want to know?

3. Child development Process of acquiring new skills Process of acquiring new skills Growth and increase in strength of muscles Growth and increase in strength of muscles Improving muscle control Improving muscle control Change in cognition Change in cognition Social relationships and personality Social relationships and personality

4. Influences on development Parent-child interaction Individual factors Environmental influence Parenting behaviour Cognitive processes- language, social emotional and perceptual motor Psychological processes-attention, self regulation,social cognition and motivation Functional competence Social, Communicative, Cognitive, Emotional

5. Child development domains Gross motor Gross motor Speech, language & hearing Speech, language & hearing Fine motor & vision Fine motor & vision Social, emotional & hearing Social, emotional & hearing

6. Gross motor Rapid progress in first 18 months Rapid progress in first 18 months Head control by 6 weeks Head control by 6 weeks Sit by 6 months Sit by 6 months Stand by 10 months Stand by 10 months Cruising 12months Cruising 12months Walks alone 15 months Walks alone 15 months

7. Gross motor cont. 15months – down stairs backwards 18months – walks well, throws ball 24months – up and down stairs – 2 feet per step,kicks a ball 36months- rides tricycle 48 months – hops on preferred foot 60months – hops on each foot 72 months – walks backwards on straight line

8. Fine motor & vision Newborn-hands closed Newborn-hands closed 6 weeks- fixes and follows to 90’,hands to mouth 6 weeks- fixes and follows to 90’,hands to mouth 3months – holds rattle 3months – holds rattle follows 180’ follows 180’ 4months – palmar grasp 4months – palmar grasp 6 months- transfers 6 months- transfers 10 months pincer grip 10 months pincer grip

9. Fine motor continued 12months – pincer grasp and releases to request, throws things to floor 18 months – scribbles, may start showing hand preference 24 months – 6 cube tower, hand preference, vertical line 36months – copies circle, cuts with scissors, threads large beads,9 cube tower 48months – copies + 60months – copies square and triangle, can draw a man 72months – copies diamond

10. Speech, language & hearing Newborn-startles to sounds 3 months - coos 6 months -babbles 10 months – waves bye-bye 12 months – 2-3 words understands simple understands simple instructions instructions 15 months – points on request 18 months - 10 words

11. Speech and language cont. 18 months – 2 word sentences 24months – short phrases 36 months – knows name, sex,pronouns talks incessantly 48months – knows colours 60months – knows opposites 72months – knows comparatives

12. Social emotional & behavioural 6 weeks smiles 6 weeks smiles 10 months plays peek-a-boo 10 months plays peek-a-boo 12 months drinks from a cup 12 months drinks from a cup 18 months symbolic play 18 months symbolic play

13. Developmental milestones Worry if…… Age No responsive smile 8 weeks No eye contact 3 months Not reaching for objects 5 months Not sitting 9 months Not walking 18 months Not saying single words 18 months No 2/3 word sentences 30 months

14. Motor development-delay if Fisting hands>3 months Fisting hands>3 months Poor head control at 4 months Poor head control at 4 months Persistence of primitive reflexes >6 months Persistence of primitive reflexes >6 months Persistence of flexor hypertonia in LL (popliteal angle >150 deg) >9 months Persistence of flexor hypertonia in LL (popliteal angle >150 deg) >9 months Not sitting independently-10 months Not sitting independently-10 months Not walking by 18 months. Not walking by 18 months.

15. Fine motor Not reaching-6 months Not reaching-6 months Persistence of hand regard >9 months Persistence of hand regard >9 months No index finger exploration -12 months No index finger exploration -12 months Lack of purposeful exploration of objects- 12 months Lack of purposeful exploration of objects- 12 months

16. Speech and language delay No clear spontaneous words-18 months No clear spontaneous words-18 months Not showing understanding of common objects/giving on request-18 months Not showing understanding of common objects/giving on request-18 months Unable to follow simple requests-27 months Unable to follow simple requests-27 months No word combinations-30 months No word combinations-30 months No 2-3 word sentences-3 yrs No 2-3 word sentences-3 yrs No ‘why’,’what’ questions/no sentences-4 yrs No ‘why’,’what’ questions/no sentences-4 yrs

17. Play and social development No pointing/gesture-12 months No pointing/gesture-12 months No joint attention-18 months No joint attention-18 months Absence of pretence play/ repetitive play- 24 months Absence of pretence play/ repetitive play- 24 months Lack of social interest-3-4 yrs Lack of social interest-3-4 yrs

18. Delayed development Global delay Global delay Specific impairments – sensory, motor, social, cognitive Specific impairments – sensory, motor, social, cognitive

19. Framework for developmental examination Systematic enquiry Eliciting concerns Eliciting concerns Current abilities Current abilities Identify risk/protective factors Identify risk/protective factors Observations of developmental abilities Observations of developmental abilities

20. Assessment Simple tools – drawing, building blocks Simple tools – drawing, building blocks Standardised tools – Denver Standardised tools – Denver Multi professional assessments (CDC) Multi professional assessments (CDC)

21. Limitations Technique – ask if not demonstrated Technique – ask if not demonstrated Range of normal very wide/variable Range of normal very wide/variable Reliability before 6 months less good Reliability before 6 months less good

22. Development regression Infection Infection Neurometabolic conditions Neurometabolic conditions Syndromes Syndromes

23. Exercise 4 groups 4 groups In each group two people take a turn being a ‘child’. In each group two people take a turn being a ‘child’. Work together to try and assess the age of the child assuming they have normal development for their age. Work together to try and assess the age of the child assuming they have normal development for their age. Feedback to the whole group. Feedback to the whole group.

24. How old? 6-8 weeks 6-8 weeks 6 months 6 months 9months 9months 12 months 12 months 18 months 18 months 2 years 2 years 3 years 3 years 4 years 4 years

25. Why assess? Normal development - reassure Pick up difficulties early Intervention Prevention Cure Support

26. Interventions Physiotherapy Physiotherapy OT OT Educational support Educational support Behavioural support (Autism, ADHD) Behavioural support (Autism, ADHD) Social and family support Social and family support Parenting skills Parenting skills Medical eg thyroxine, hearing aid, steroids Medical eg thyroxine, hearing aid, steroids

27. Case 1 6y girl 6y girl Special school Special school

28. Case 2 5y old boy 5y old boy Weak Weak Unable to climb stairs Unable to climb stairs Mild learning disability Mild learning disability

29. Case 3 4 y old boy 4 y old boy Doesn’t speak Doesn’t speak Poor eye contact Poor eye contact Doesn’t participate in lessons Doesn’t participate in lessons

30. Case 4 Born at 24 weeks gestation Born at 24 weeks gestation Grade 4 IVH Grade 4 IVH Increased tone in legs Increased tone in legs Global developmental delay Global developmental delay

31. Child Development Unit Multi disciplinary team Multi disciplinary team Assess needs Assess needs Inform Educational process Inform Educational process Coordinate care package Coordinate care package

32. Any questions ?

33. Summary Child development – we have covered: Child development – we have covered: –What is it? –How do we assess it? –Why do we want to know? –Thanks to Dr. Callaghan and Dr.Kim Neuling