Child Development: Tewfik Daradkeh, M.D. Division Psychiatry Department of Neuroscience Just

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Child Development

July, 04, 2010

Tewfik Daradkeh, M.D. Division Psychiatry Department of Neuroscience JUST

Goals

Develop an understanding of different dimensions of development Identify developmental concepts that will be important in future clinical work Provide roadmap for the behavioral assessment of children, based on understanding of normal development Stimulate your interest in learning more about this exciting topic, beyond the lecture

Developmental Considerations
Is the child at an age-appropriate level?
Issues: Chronological age (CA) versus mental age (MA) Developmental milestones, e.g. DENVER Developmental theories of Piaget, Erikson, Mahler etc. Age-appropriate problem-phases (e.g. terrible 2s)

Dimensions of Development

Physical growth and motor skills Temperament Cognition and intelligence Language Social relations and attachment

Growth in Height and Weight from 2-18 Years


Height 190 180 170 Centimeters 160 150 140 130 120 110 100 90 80 2 4 Girls 74.9 90 80 72 64 56 Kilograms 48 40 32 24 16 Girls 35.4 31.5 6 8 10 12 14 16 18 Age in Years 8 0 2 4 6 8 17.6 0 10 12 14 16 18 Inches Boys Weight 194.0 176.3 158.7 141.1 123.4 Pounds 105.8 88.2 70.5 52.9 35.3

Boys

70.9 66.9 63.0 59.0 55.1 51.2 47.2 43.3 39.4

Age in Years

Milestones of Motor Development

Motor Skills-Summary
Age 2-up stairs w/o help
Age 3-tricycle, copies circle Age 4-hops, copies square Age 5-skips, copies triangle

Developmental Milestones

Developed by Arnold Gesell and Colleagues Objective observation of large numbers of children at various ages Assessment of gross and fine motor, personal-social, and language domains DENVER II Developmental Screening Test provides age ranges of normal appearance of various milestones up to age 6 years Recently revised and restandardized; very widely used

The Concept of Temperament


Pioneers of Temperament research: Thomas and Chess (New York Longitudinal Study : 85 middle-class families with 133 children) Three recognized clusters: Easy child (Positive mood; regular; adaptable; low intensity; positive to novelty) 40% Difficult child 10 % Slow-to-warm-up (Negative response to novelty; mild intensity; gradual adaptation after repeated contact) 18% Contemporary research (e.g., Goldsmith; Rothbart; Buss & Plomin): fewer dimensions than Thomas & Chess emotional processing, self-regulation; effortful control; activity level

Theory of Cognitive Development


Pioneered by Jean Piaget (1896-1980) Theory assumes that cognitive development is influenced by maturation, experience, and social learning, and constructed through self-motivated action in the world. Original theory proposed 4 stages; neo-piagetian researchers have challenged the number and definitions of stages; other cognitive developmentalists have challenged stage theory and propose more domain-specific knowledge development.

Piagets original four stages

Sensorimotor stage: from birth to age 2 years (children experience the world through movement and senses and learn object permanence) Preoperational stage: from ages 2 to 7 (acquisition of motor skills; egocentric stage) Concrete operational stage: from ages 7 to 11 (children begin to think logically about concrete events, develop understanding of conservation, seriation, reversibility) Formal operational stage: after age 11 (development of abstract reasoning).

Cognitive Development
Sensorimotor Stage: Object Permanence

Original Setup

Alter as Shown

Ask Child Which has more liquid?

Usual Answer of Preoperational Child

Conservation of liquid

Has more Do they both weigh the same, or does one weigh more than the other?

Conservation of mass

Weighs more

Conservation of number

Are there still as many pennies as nickels, or more of one than the other?

More

Conservation of length

Are they the same length, or is one longer? Is longer

Conservation of length

Is one pencil as long as the other, or is one longer?

Formal Operations Stage


Thinking in a New Key
Concrete

logic to abstract thinking (thinking about thinking) Ifthen Alternatives Future perspective Shades of Gray Empathy & Perspective

Summary of Piagets Stages of Cognitive Development

Responses to One of Kohlbergs Moral Dilemmas by People at Six Levels of Moral Reasoning The dilemma: Heinzs wife was near death from cancer. A druggist had recently discovered a drug that might be able to save her. The druggist was charging $2000 for the drug, which cost him $200 to make. Heinz could not afford to pay for it, and he could borrow only $1000 from friends. He offered to pay the rest later. The druggist refused to sell the drug for less than the full price paid in advance: I discovered the drug, and Im going to make money from it. Late that night, Heinz broke into the store to steal the drug for his wife. Did Heinz do the right thing

Responses to One of Kohlbergs Moral Dilemmas by People at Six Levels of Moral Reasoning The dilemma: Heinzs wife was near death from cancer. A druggist had recently discovered a drug that might be able to save her. The druggist was charging $2000 for the drug, which cost him $200 to make. Heinz could not afford to pay for it, and he could borrow only $1000 from friends. He offered to pay the rest later. The druggist refused to sell the drug for less than the full price paid in advance: I discovered the drug, and Im going to make money from it. Late that night, Heinz broke into the store to steal the drug for his wife. Did Heinz do the right thing

Language Development

About 8,000 languages in the world, each with rules for


phonology (phonemes or speech sounds [~ 70] or, in the case of signed language, hand-shapes), morphology (word formation), syntax (sentence formation), semantics (word and sentence meaning), prosody (intonation and rhythm of speech), pragmatics (effective use of language).

Baby able to detect any possible phoneme; within months start to specialize according to input patterns of mother tongue Phonetic maps are created, and eventually only phonemes represented on map can be heard

Milestones of Language Development


Birth to 5 months

12 - 17 months

Reacts to loud sounds. Turns head toward a sound source. Watches your face when you speak

Attends to a book or toy for about two minutes. Follows simple directions accompanied by gestures. Answers simple questions nonverbally.

6 - 11 months

Understands "no-no". Babbles (says "ba-ba-ba" or "mama-ma"). Tries to communicate by actions or gestures. Tries to repeat your sounds.

(Source: http://www.nidcd.nih.gov/health/voice/speechandlanguage.asp#mychild)

Milestones of Language Development


18 - 23 months

2 - 3 years

Enjoys being read to. Follows simple commands without gestures. Points to simple body parts such as "nose." Understands simple verbs such as "eat," "sleep." Says 8 to 10 words (pronunciation may still be unclear).

Knows some spatial concepts such as "in," "on and pronouns such as "you," "me," "her." Knows descriptive words such as "big," "happy. Says around 40 words at 24 months. Answers simple questions. Begins to use more pronouns such as "you," "I." Speaks in two to three word phrases.

Milestones of Language Development


3 - 4 years Groups objects such as foods, clothes, etc. Identifies colors. Strangers are able to understand much of what is said. . Has fun with language. Enjoys poems and recognizes language absurdities such as, "Is that an elephant on your head?" Expresses ideas and feelings rather than just talking about the world around him or her. 4 - 5 years Understands spatial concepts such as "behind," "next to. Understands complex questions. Speech is understandable but makes mistakes pronouncing long, difficult, or complex words Says about 200 - 300 different words. Uses some irregular past tense verbs such as "ran," "fell.

Milestones of Language Development


5 years

Understands more than 2,000 words. Understands time sequences (what happened first, second, third, etc.). Carries out a series of three directions.. Uses imagination to create stories.

Social Development
John Bowlby (1907-1990)
studied attachment from multiple perspectives (psychology; evolution; ethology) Need secure relationship with caregivers to ensure normal social and emotional development;also adaptive/protective b/c attachment keeps protectors near Bonding involves active, reciprocal interactions and these social interactions with attachment figures lead to the development of an internal working model of social relationships

Innate nature of attachment behavior


Attachment occurs in spite of maltreatment, inanimate objects can serve for attachment Attachment assessment through strange situation protocol (Ainsworth) Not all forms of attachment are equal:

Secure Avoidant -Insecure Ambivalent Disorganized-Insecure

Dance of Attachment/Bonding

Full-Term Newborn

Parent

has organized states attends selectively behaves in interpretable ways systematic responses to parents acts in temporarily predictable ways learns from, adapts to parents behavior

helps regulate states provides necessary stimuli searches for communicative intent wants to influence newborn and feel effective adjusts to newborns temporal rhythms acts repetitively and predictably

Separation-Individuation
Margaret Mahler Children learn to identify the boundaries between self-caretaker, and negotiate a balance between attachment and independence. Coined terms of differentiation, separation individuation, practicing, rapprochement, object constancy.

Object permanence = Piagetian term (out of sight.) Object constancy = frustrating mother and comforting mother are the same person

Separation-Individuation
Birth

to 5 months: symbiosis 5-10 months: Differentiation (explore body; stranger anxiety) 10-15 months: Practicing (walking; exploration; separation anxiety) 18-24 months: Rapprochement (self-awareness develops; conflict over closeness/exploration) 24-36 months: Consolidation and object constancy (internal representation of mother; tolerates separation, knowing reunion will occur)

Age-appropriate Problem-Phases
Problem
Separation anxiety

Also known as
Mom cant leave the room phase Terrible twos night light phase band-aid phase

AGE
10-16 months

Defiance Dear of darkness Fear of bodily injury

18-30+ months 2-8 years 5-7 years

Psychosocial Development

Pioneered by Erikson (1902 1994)


Psycho-analyst and contemporary of Anna Freud Proposed that developmental phases continue throughout life. Major themes have to be successfully negotiated in each phase, and resolution of conflict results in virtue or psychological capacities. Outcomes of prior phases influence how a person masters the next level.

Eriksons Psychosocial Stages


Late Adulthood 60s and over Middle Adulthood 40s and 50s Young Adulthood 20s and 30s Adolescence 12 - late teens Middle Childhood 6/7 - 11/12 yrs Early childhood 2 - 6/7 yrs Infancy 1 - 2 yrs Infancy 0 - 1yrs Initiative vs. guilt Integrity vs. Despair Generativity vs. Stagnation

Intimacy vs. Isolation

Identity vs. Role Confusion

Industry vs. Inferiority

Autonomy vs. Shame/doubt

Trust vs. Mistrust

Eriksons Ages of Human Development

Shifting Focus of Assessment: Infants and Toddlers

Observation

Gross and fine motor functions Language and communication Social behavior Bonding Delayed development (e.g. MR) Abnormal development (e.g. PDD) Poor bonding (e.g. neglect, abuse)

Common referral reasons:


Shifting Focus of Assessment: Preschoolers

Observation, personal interview


Observe milestones Assess what child talks and thinks about (e.g. through play) Parent-child relations

Common referral reasons:


Delayed development (e.g. MR),Abnormal development (e.g. PDD), Poor bonding (e.g. neglect, abuse) Speech-language delays Hyperactivity Aggressive/defiant behaviors Excessive anxiety Toilet training

Shifting Focus of Assessment: School-age Child

Observation, interviews, reports from school


How does child function in family? How does child function in school? (behavior and academics) What kind of peer relations? Formal psychological and academic testing

Common referral reasons:


Learning problems Externalizing conditions (ADHD, ODD) Separation anxiety

Summary

Understanding of normal development is essential for child psychiatric evaluation. Child psychiatric assessment techniques need to be adjusted for developmental level. Integrate developmental assessment into observations and interviews, obtain collateral information from schools and testing as needed to aid in diagnosis.

Behavioral milestones for a 2-yearold


Building an eight-cube tower Climbing stairs Domestic mimicry Playing interactive games Pulling on clothes Referring to self by name Separation anxiety is diminishing Using fifty words and word combinations

Behavioral milestones for a 3year-old


Building a ten-cube tower Drawing a circle Feeding self Going up stairs using alternative feet Putting on shoes Riding tricycle Unbuttoning Understanding on taking turns

Behavioral milestones for a 4year-old

Brushing teeth Copying a cross Counting three objects Playing cooperative game Walking down stairs Washing and drying face

Behavioral milestones for a 5year-old

Controlling sphincters Drawing a square Drawing a recognizable person Counting ten objects Dressing and undressing self

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