issues in developmental disabilities normal and atypical human growth and development lecture...
TRANSCRIPT
Issues in Developmental DisabilitiesNormal and Atypical
Human Growth and Development
Lecture Presenter:
Mary Pearlman, M.D.
Why Learn Development?
Knowledge about Development is necessary for Assessment Goal Setting Treatment Strategy Choices
Assessment
Differential Diagnosis: Differential Diagnosis is all the possible
causes of a set of symptoms
Differential Diagnosis A Differential Diagnosis of Fever:
Flu Appendicitis Diurnal temperature variation Malaria Malingering Bladder infection Alien possession Just exercised
(Partial List)
Assessment
When presented with a symptom a clinician has to determine which of the many possible causative factors are involved in the symptom in front of them now
Effective treatments for different causes are often different.
Why Learn Development: Examples Assessment:
Marc, a 6 year old boy is brought for assessment of possible impulsive behavior, not following commands, and kissing peers. He has been held back a year in school for problems with reading and math. He is a behavioral problem for everyone. He is very active compared to age peers. He speaks in 3 word sentences. He needs supervision to dress and can’t button up. He just started riding a tricycle. He can copy a circle but not a cross.
Differential Diagnosis: (partial list)
Attention Deficit Disorder Conduct Disorder Mental Retardation
Assessment
This copy of the Denver Developmental Screen Exam may help you with Marc’s Assessment.
DDST
Marc 6 year old boy
Boys Function Mental Age (years)
Personal-Social
Needs supervision to dressCan’t button self
3
Fine Motor-Adaptive
Copy CircleNot Copy Cross
3
Language 3-word sentencesNo reading/letters
3
Gross Motor Pedals tricycle 3
DDST
Assessment
IQ = 100 x Mental Age / Chronologic Age
IQ = 100 x 3 yrs / 6 yrs
IQ = 50
Assessment
A knowledge of development allows us to diagnose Marc as probably having mental retardation.
Social development is consistent with mental age. Marc’s behavior is similar to other 3-year-olds.
Why Learn Development?
Knowledge of development helps with Goal Setting
Goal Setting Teaching “Following Commands”
Marc stops an activity when told “No”. Marc will not make his bed independently. Marc can spend 5 minutes learning new
material. He can enjoy familiar material for about ½ hour. Marc cannot read the clock. He knows “Day”,
“Night”, “School time”, “Lunch time”, “Bedtime”, and “Suppertime”.
Cartoon - Real Life Adventures
Goal Setting Parents want Marc to learn to do chores
and be responsible. They want him to learn to change his bed
because he wets his bed Behavior Program:
Marc can earn a star at lunch time if he puts his dirty PJ’s down the chute, the dirty sheets down the chute and if he puts the new sheet on the bed. Mom has demonstrated this skill
Will this behavior program work?
Goal Setting
No Time between activity and reward too long Activity has too many separate parts for a 3-
year-old to remember Activity requires fine motor skills too
advanced. Activity requires more strength than Marc
has Marc has button PJ’s. He can’t manage
buttons yet.
Cartoon
Goal Setting
A knowledge of Development would suggest more developmental age-appropriate responsible tasks. Clearing dishes from the table to the
counter top. Emptying small waste baskets Wiping the sink after he brushes his
teeth Putting cans in recycling.
Goal Setting
Rewards should occur soon (5 min) after Task Completion. “Thanks, Marc! You were a big help.” “We have our chores done. Let’s color.”
Development: Treatment Strategy Choices
Marc’s bedwetting is truly a problem for the parents. They want him to stop.
Is this possible given Marc’s mental age?
Rx Strategy Choices Development – Bedwetting Gesell: Elimination—Developmental
Sequences = 36 months. Responds to routine times Goes by self - during day, but announces May hold of too long, dancing up and down, may
accidentally wet Needs help with buttons Attempts to wipe self, not too successful Median age 42 months – dry at night
This means a significant minority of children are not toilet trained at night at 42 months.
Rx Strategy Choices Knowledge of Development suggests that it
may be Normal developmentally for Marc to still wet at night. His chronologic age is 6-years. His mental + social age is 3-years.
What are the best treatment choices? The parents need relief. The parents will
benefit from developmental education.
Knowledge of Development
Knowledge of Development helps with Treatment Strategy Choices
Treatment can be based on: Environmental modification Prevention Positive Reinforcement Negative Reinforcement Punishment
Cartoon
Rx Choices Knowledge of Development helps with
Strategy Choices Environmental Modification: Yes – use
chucks, pull up big boy diapers Prevention: Yes – limit drinking after
suppertime. AM bath to clean up Positive Reinforcement: Yes – throwing away
wet chuck or diaper inappropriately. Negative Reinforcement: Maybe – if discards
chuck or diaper inappropriately. Has to go back and do appropriately.
Behavior Management
These Behavior Management Strategies need to be used to teach desirable behaviors in successive approximations.
Rx Choices
Punishment: May make things worse – Child frightened more wetting, trouble
sleeping. Child angry and less compliant, more
distant
Cartoon - P.S. Mueller
Why Learn Development: Summary
Knowledge of Development is necessary for: Assessment Goal Setting Treatment Strategy Choices
Don Anderson’s Note
Understanding normal or typical development is the primary foundation prior to the study of developmental disabilities and atypical or varied course in development.
Normal Development: Childhood
Developmental Lines: Definition An skill that can be observed and
assessed from birth to death, that involves one functional area. The acquisition of skills is an orderly process, succeeding skills based on earlier skills in that functional area.
Normal Development: Childhood Examples of Developmental Lines
Motor skills, gross and fine Perceptual skills Impulse Control Cognitive Skills Play skills Social Relations/ Attachment Speech and Language
Normal Development: Infancy
Babies are born with a set of skills Reflexes Readiness to
Orient to voice Orient to caretaker Self-management skills
Normal Development: Infancy Self Management Skills Described by T. Berry Brazelton, M.D.
who developed a neonatal development assessment scale based on these items.
Sharing the results of this assessment with caretakers gave the parents more self confidence and effectiveness in dealing with the infancy period of development.
Normal Development: Infancy
Temperament: Definition The set of innate tendencies, or
dispositions, that underlie and affect each person’s interactions with people, situations and events
Normal Development: InfancyTemperamental Characteristics
Activity Level Rhythmicity Approach –withdrawal Adaptability Intensity of reaction Threshold of responsiveness Quality of mood Distractibility Attention span
Normal Development: InfancyTasks of the Infant Period
Tasks of the infant period Feeding/Elimination State-Regulation Learning about the perceptual and
sensory Learning early motor skills Attachment Early logic Language readiness and imitation skills
Normal Development: InfancyAttachment
Attachment Reciprocal interaction in the mother
child relationship in infancy. Research done by T. Berry Brazelton
Normal Development: InfancyCommunication
Talking with the eyes: Social referencing Drawing adult’s attention to object of
interest Negation Emotional expression
Normal Development: Infancy
By 4 months of age A mother can distinguish the meaning
of the baby’s different cries The baby can wait to feed, if mother
says “coming, baby”.
Normal Development: Childhood Piaget’s Periods of Cognitive Development
0-2yrs: Sensorimotor 2-6yrs: Preoperational 7-11yrs: Concrete operational 12yrs-adult: Formal operational Some adults age varies: Post
operational
Normal Development: Childhood
Play as an exemplar of Piagetian theory
Normal Development: Childhood
Gender Identity exploration reflects Piagetian Cognitive Development
Normal Development: Childhood
Language and symbol formation Truckness
Suck the truck Bang the truck Roll the truck on fabric and spin the
wheels Watch a real truck outside and hold up
the little truck and say ”truck”
Normal Development: Childhood
Attachment and Piaget contribute to conscience development
Normal Development: Childhood
Socialization at different ages
Normal Development: Childhood
Autism and atypical developmental course