Developmental Assessment

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Developmental Assessment

• Dhaara Iyer (ST5)
• October 2011

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Learning objectives

• What is development?
• What is normal/abnormal?
• How do you assess it?
• Why do we want to know?

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Child development

• Process of acquiring new skills
• Growth and increase in strength of muscles
• Improving muscle control
• Change in cognition
• Social relationships and personality

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

• Gross motor
• Speech, language hearing
• Fine motor vision
• Social, emotional hearing

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Gross motor

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

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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

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Fine motor vision

• Newborn-hands closed
• 6 weeks- fixes and follows to 90,hands to mouth
• 3months holds rattle
• follows 180
• 4months palmar grasp
• 6 months- transfers
• 10 months pincer grip

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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

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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
• instructions
• 15 months points on request
• 18 months - 10 words

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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

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Social emotional behavioural

• 6 weeks smiles
• 10 months plays peek-a-boo
• 12 months drinks from a cup
• 18 months symbolic play

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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
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Motor development-delay if

• Fisting handsgt3 months
• Poor head control at 4 months
• Persistence of primitive reflexes gt6 months
• Persistence of flexor hypertonia in LL (popliteal
  angle gt150 deg) gt9 months
• Not sitting independently-10 months
• Not walking by 18 months.

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Fine motor

• Not reaching-6 months
• Persistence of hand regard gt9 months
• No index finger exploration -12 months
• Lack of purposeful exploration of objects-12
  months

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Speech and language delay

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

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Play and social development

• No pointing/gesture-12 months
• No joint attention-18 months
• Absence of pretence play/ repetitive play-24
  months
• Lack of social interest-3-4 yrs

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Delayed development

• Global delay
• Specific impairments sensory, motor, social,
  cognitive

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Framework for developmental examination

• Systematic enquiry
• Eliciting concerns
• Current abilities
• Identify risk/protective factors

• Observations of developmental abilities

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Assessment

• Simple tools drawing, building blocks
• Standardised tools Denver
• Multi professional assessments (CDC)

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Limitations

• Technique ask if not demonstrated
• Range of normal very wide/variable
• Reliability before 6 months less good

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Development regression

• Infection
• Neurometabolic conditions
• Syndromes

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Exercise

• 4 groups
• 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.
• Feedback to the whole group.

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How old?

• 6-8 weeks
• 6 months
• 9months
• 12 months
• 18 months
• 2 years
• 3 years
• 4 years

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Why assess?

• Normal development - reassure
• Pick up difficulties early
• Intervention
• Prevention
• Cure
• Support

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Interventions

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

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Case 1

• 6y girl
• Special school

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Case 2

• 5y old boy
• Weak
• Unable to climb stairs
• Mild learning disability

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Case 3

• 4 y old boy
• Doesnt speak
• Poor eye contact
• Doesnt participate in lessons

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Case 4

• Born at 24 weeks gestation
• Grade 4 IVH
• Increased tone in legs
• Global developmental delay

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Child Development Unit

• Multi disciplinary team
• Assess needs
• Inform Educational process
• Coordinate care package

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Any questions ?
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Summary

• 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