Developmental Developmental AssessmentAssessment

Dhaara Iyer (ST5)Dhaara Iyer (ST5)October 2011October 2011

Learning objectivesLearning 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?

Child developmentChild development

• Process of acquiring new skillsProcess of acquiring new skills

• Growth and increase in strength of Growth and increase in strength of musclesmuscles

• Improving muscle controlImproving muscle control

• Change in cognitionChange in cognition

• Social relationships and personalitySocial relationships and personality

Influences on development Influences on development

Parent-child interactionIndividua

l factorsEnvironmental influence

Parenting behaviour

Cognitive processes-language, social emotional and

perceptual motor

Psychological processes-

attention, self regulation ,social

cognition and motivation

Functional competenceSocial, Communicative, Cognitive,

Emotional

Child development domainsChild development domains

• Gross motorGross motor

• Speech, language Speech, language & hearing& hearing

• Fine motor & visionFine motor & vision

• Social, emotional & Social, emotional & hearing hearing

Gross motorGross motor

• Rapid progress in Rapid progress in first 18 monthsfirst 18 months

• Head control by 6 Head control by 6 weeksweeks

• Sit by 6 monthsSit by 6 months• Stand by 10 monthsStand by 10 months• Cruising 12monthsCruising 12months• Walks alone 15 Walks alone 15

monthsmonths

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

Fine motor & visionFine motor & vision

• Newborn-hands closedNewborn-hands closed

• 6 weeks- fixes and follows to 6 weeks- fixes and follows to 90’,hands to mouth90’,hands to mouth

• 3months – holds rattle3months – holds rattle

• follows 180’follows 180’

• 4months – palmar grasp4months – palmar grasp

• 6 months- transfers6 months- transfers

• 10 months pincer grip10 months pincer grip

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

Speech, language & hearing Speech, language & hearing Newborn-startles to soundsNewborn-startles to sounds

3 months - coos3 months - coos

6 months -babbles6 months -babbles

10 months – waves bye-bye10 months – waves bye-bye

12 months – 2-3 words12 months – 2-3 words

understands simpleunderstands simple

instructions instructions

15 months – points on request15 months – points on request

18 months - 10 words18 months - 10 words

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

Social emotional & Social emotional & behaviouralbehavioural

• 6 weeks smiles6 weeks smiles

• 10 months plays 10 months plays peek-a-boopeek-a-boo

• 12 months drinks 12 months drinks from a cupfrom a cup

• 18 months 18 months symbolic playsymbolic play

Developmental milestonesDevelopmental milestones

Worry if……Worry if…… AgeAge

No responsive smileNo responsive smile 8 weeks8 weeks

No eye contactNo eye contact 3 months3 months

Not reaching for Not reaching for objectsobjects

5 months5 months

Not sittingNot sitting 9 months9 months

Not walkingNot walking 18 months18 months

Not saying single Not saying single wordswords

18 months18 months

No 2/3 word No 2/3 word sentencessentences

30 months30 months

Motor development-delay ifMotor development-delay if

• Fisting hands>3 monthsFisting hands>3 months

• Poor head control at 4 monthsPoor head control at 4 months

• Persistence of primitive reflexes >6 Persistence of primitive reflexes >6 monthsmonths

• Persistence of flexor hypertonia in LL Persistence of flexor hypertonia in LL (popliteal angle >150 deg) >9 months(popliteal angle >150 deg) >9 months

• Not sitting independently-10 monthsNot sitting independently-10 months

• Not walking by 18 months.Not walking by 18 months.

Fine motorFine motor

• Not reaching-6 monthsNot reaching-6 months

• Persistence of hand regard >9 Persistence of hand regard >9 monthsmonths

• No index finger exploration -12 No index finger exploration -12 monthsmonths

• Lack of purposeful exploration of Lack of purposeful exploration of objects-12 monthsobjects-12 months

Speech and language delaySpeech and language delay

• No clear spontaneous words-18 monthsNo clear spontaneous words-18 months

• Not showing understanding of common Not showing understanding of common objects/giving on request-18 monthsobjects/giving on request-18 months

• Unable to follow simple requests-27 monthsUnable to follow simple requests-27 months

• No word combinations-30 monthsNo word combinations-30 months

• No 2-3 word sentences-3 yrsNo 2-3 word sentences-3 yrs

• No ‘why’,’what’ questions/no sentences-4 No ‘why’,’what’ questions/no sentences-4 yrsyrs

Play and social developmentPlay and social development

• No pointing/gesture-12 monthsNo pointing/gesture-12 months

• No joint attention-18 monthsNo joint attention-18 months

• Absence of pretence play/ repetitive Absence of pretence play/ repetitive play-24 monthsplay-24 months

• Lack of social interest-3-4 yrsLack of social interest-3-4 yrs

Delayed developmentDelayed development

• Global delayGlobal delay

• Specific impairments – sensory, Specific impairments – sensory, motor, social, cognitivemotor, social, cognitive

Framework for Framework for developmental examinationdevelopmental examination

Systematic enquirySystematic enquiry

• Eliciting concernsEliciting concerns

• Current abilitiesCurrent abilities

• Identify Identify risk/protective risk/protective factorsfactors

Observations of Observations of developmental developmental abilitiesabilities

AssessmentAssessment

• Simple tools – drawing, building Simple tools – drawing, building blocksblocks

• Standardised tools – DenverStandardised tools – Denver

• Multi professional assessments (CDC)Multi professional assessments (CDC)

LimitationsLimitations

• Technique – ask if not demonstratedTechnique – ask if not demonstrated

• Range of normal very wide/variableRange of normal very wide/variable

• Reliability before 6 months less goodReliability before 6 months less good

Development regressionDevelopment regression

• InfectionInfection

• Neurometabolic conditionsNeurometabolic conditions

• SyndromesSyndromes

ExerciseExercise

• 4 groups4 groups

• In each group two people take a turn In each group two people take a turn being a ‘child’.being a ‘child’.

• Work together to try and assess the Work together to try and assess the age of the child assuming they have age of the child assuming they have normal development for their age.normal development for their age.

• Feedback to the whole group.Feedback to the whole group.

How old?How old?

• 6-8 weeks6-8 weeks• 6 months6 months• 9months9months• 12 months12 months• 18 months18 months• 2 years2 years• 3 years3 years• 4 years4 years

Why assess?

•Normal development - reassure

•Pick up difficulties early

• Intervention

•Prevention

•Cure

•Support

InterventionsInterventions

• PhysiotherapyPhysiotherapy

• OTOT

• Educational supportEducational support

• Behavioural support (Autism, ADHD)Behavioural support (Autism, ADHD)

• Social and family supportSocial and family support

• Parenting skillsParenting skills

• Medical eg thyroxine, hearing aid, Medical eg thyroxine, hearing aid, steroids steroids

Case 1Case 1

• 6y girl 6y girl

• Special schoolSpecial school

Case 2Case 2

• 5y old boy5y old boy

• WeakWeak

• Unable to climb Unable to climb stairsstairs

• Mild learning Mild learning disabilitydisability

Case 3Case 3

• 4 y old boy4 y old boy

• Doesn’t speakDoesn’t speak

• Poor eye contactPoor eye contact

• Doesn’t participate in lessonsDoesn’t participate in lessons

Case 4Case 4

• Born at 24 weeks Born at 24 weeks gestationgestation

• Grade 4 IVHGrade 4 IVH

• Increased tone in legsIncreased tone in legs

• Global developmental Global developmental delaydelay

Child Development UnitChild Development Unit

• Multi disciplinary Multi disciplinary teamteam

• Assess needsAssess needs

• Inform Educational Inform Educational processprocess

• Coordinate care Coordinate care packagepackage

Any questions ?Any questions ?

SummarySummary

• Child development – we have covered:Child development – we have covered:– What is it?What is it?– How do we assess it?How do we assess it?– Why do we want to know?Why do we want to know?

– ThanksThanks to Dr. Callaghan and Dr.Kim to Dr. Callaghan and Dr.Kim NeulingNeuling