Developmental Issues in Early Childhood and Elementary Age

1. Developmental Issues in Early Childhood and Elementary Age Kelly L. Lange, Ph.D. Clinical Neuropsychologist

2. Goals for this talk • Rationale for identifying possible problems • Barriers in identifying problems • Skill development & possible problems • Addressing concerns with parents • Making appropriate referrals

3. Why should we identify potential problems? • Opportunity • Expectations • Potential for positive life-long impact • Quality education of the whole child • Struggling child affects the whole class

4. Why we might not want to address concerns • “This isn’t my area of expertise.” • “How do I really know it could be a problem?” • “This looks so mild that I’m not really sure I should say something.” • “I don’t believe in labels.” • “I don’t know what to tell these parents or how to say it.”

5. Issues in Considering Development • History: Genetics + Environment • Some kids have a greater risk of problems: • Prematurity • Genetic and metabolic disorders • Medical problems with pregnancy & delivery • Adoption/IVF • Drug abuse and domestic violence • Historical info may not always be available

6. Major Domains of Child Development • Social/emotional skills • Motor skills • Language skills • Other cognitive skills: • Visuospatial skills • Attention & executive functions • Memory • Academics

7. Seeking and maintaining eye contact Making and maintaining friendships with peers Joining activities and conversations Interpreting and expressing empathy Regulating negative emotions like frustration and anger Developing self-soothing skills Giving and receiving affection Recognizing and using personal boundaries for conversational topics and physical interaction Social reciprocity Creating relationships with adults other than parents Responding appropriately to novel situations, routines and people Identifying role changes when engaging with adults, peers, and older and younger children Learning basic social schemas Identifying one’s own and others’ emotions and acknowledging that a range of emotions is “normal” Requesting help when needed Social/Emotional Functioning

8. Gross motor: Running Jumping Climbing Balancing Fine motor: Cutting Drawing/writing Zipping Buttoning Snapping Scooping Pouring Tying shoes Motor Functioning

9. Speech: Articulation (making sounds accurately) Using appropriate pitch Using inflection and intonation Speaking at appropriate rate Controlling impulsive speech Using speech spontaneously Fluently naming colors, numbers,letters, etc. Language: Recognizing grammatical constructs Interpreting/hearing verbal messages accurately Identifying sarcasm, joking, teasing Knowing and using conversational schemas Using appropriate “person” reference (talking about oneself in 1st vs. 3rd person) Language Skills

10. Visuospatial: Recognizing patterns Identifying items on a background Sequencing Discriminating items Memory: Repeating what was just heard/read/seen Retaining info over a delay (for an hour or a few months) Remembering both verbal and visual info Executive Functions: Organizing Planning Imagining Thinking before doing Keeping multiple things in mind Multitasking Using contextual info Making associations between new and old info Reasoning/logical thinking Other Cognitive Skills

11. Child’s speech is difficulty to understand Persistent drooling Doesn’t engage in fantasy play Doesn’t use “me” and “you” appropriately Cannot copy circle Difficulty scribbling Excessive difficulty separating from parents Little response with people outside of family Little/no interest in interactive games Lashing out/raging when angry or upset Cannot grasp crayon with thumb and fingers Ignores other children Doesn’t use sentences with >3 words Concerns in 3 & 4-year-olds http://aap.org/healthtopics/stages.cfm#early

12. Extremely fearful or timid Extremely aggressive Difficulty concentrating for > 5 min Little interest in playing with other kids Refuses to respond to other people or does so superficially Rarely uses fantasy or imitation in play Seems unhappy or sad much of the time Limited interests or activity choices Avoids or seems aloof with children and adults Limited emotional expression Difficulty dressing or toileting Cannot wash hands or brush teeth efficiently Cannot understand two-part commands Seems very passive Concerns in 4 & 5-year-olds http://aap.org/healthtopics/stages.cfm#early

13. Concerns in children 6+ • Difficulty sustaining, dividing, shifting attention • Difficulty completing homework efficiently • Excessive disorganization • Persistent sadness, anxiety, school refusal • Disruptive behavior during classroom work • Frequently misunderstanding verbal messages • Difficulty making and maintaining friendships • Unusual errors in reading and arithmetic • Difficulty learning letter-sound associations http://www.ldonline.org/ldbasics/signs

14. Approaching Parents with Concerns • Let parents know that you look for developmental issues • Be authoritative yet supportive • Give constant feedback from the start of school • Establish a connection with parents early on • Collect evidence • Anecdotes • Observations • Written/drawn work • Check out your suspicions with colleague; “Am I on the right track?” • Mention your growing concern; “I think we should talk more” • Suggest a course of action • Wait and see • Try this at home (and make recommendations) • Make a referral

15. Making Referrals • What are the concerns? • Are there medical issues? • How old is the child? • Does the family have adequate financial resources? • Is there suspicion that the family is withholding information?

16. Comparing Allied Health Professionals

17. What Allied Health Professionals Look At

18. Comparing Advanced Professionals

19. What Advanced Professionals Look At

20. Regional Center Specific referral process - may require pediatrician’s involvement Diagnoses, evaluations, & therapeutic interventions are available Typical program provides free services Local Public School District Family calls the Special Education Department to request an evaluation Children may qualify for existing services Families do NOT need to attend public schools to use this service When Families Choose Public Services For Ages 0-5: For Ages 5+:

21. Comparing Educational Referrals

22. Monitoring Progress Wherever families choose to get help: • ask for updates • be involved, if you can • give parents feedback about progress • be honest about any conflicts that arise

23. Development Books That I Like “Einstein Never Used Flash Cards” By Kathy Hirsh-Pasek & Roberta Michnick Golinkoff “Your Child’s Growing Mind” By Jane Healy