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Developmental Assessment

Developmental Assessment. Dhaara Iyer (ST5) October 2011. Learning objectives. What is development? What is normal/abnormal? How do you assess it? Why do we want to know?. Child development. Process of acquiring new skills Growth and increase in strength of muscles

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Developmental Assessment

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  1. Developmental Assessment DhaaraIyer (ST5) October 2011

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

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

  4. 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

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

  6. 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

  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 • 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

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

  13. Developmental milestones

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

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

  16. 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

  17. 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

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

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

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

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

  22. Development regression • Infection • Neurometabolic conditions • Syndromes

  23. 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.

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

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

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

  27. Case 1 • 6y girl • Special school

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

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

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

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

  32. Any questions ?

  33. 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.KimNeuling

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