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Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D.

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Page 1: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Issues in Developmental DisabilitiesNormal and Atypical

Human Growth and Development

Lecture Presenter:

Mary Pearlman, M.D. 

Page 2: Issues in Developmental Disabilities Normal 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

Page 3: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Assessment

Differential Diagnosis: Differential Diagnosis is all the possible

causes of a set of symptoms

Page 4: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Differential Diagnosis A Differential Diagnosis of Fever:

Flu Appendicitis Diurnal temperature variation Malaria Malingering Bladder infection Alien possession Just exercised

(Partial List)

Page 5: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 6: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 7: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Differential Diagnosis: (partial list)

Attention Deficit Disorder Conduct Disorder Mental Retardation

Page 8: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Assessment

This copy of the Denver Developmental Screen Exam may help you with Marc’s Assessment.

Page 9: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

DDST

Page 10: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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

Page 11: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

DDST

Page 12: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Assessment

IQ = 100 x Mental Age / Chronologic Age

IQ = 100 x 3 yrs / 6 yrs

IQ = 50

Page 13: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 14: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Why Learn Development?

Knowledge of development helps with Goal Setting

Page 15: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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”.

Page 16: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Cartoon - Real Life Adventures

Page 17: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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?

Page 18: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 19: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Cartoon

Page 20: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 21: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.”

Page 22: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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?

Page 23: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 24: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 25: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Knowledge of Development

Knowledge of Development helps with Treatment Strategy Choices

Treatment can be based on: Environmental modification Prevention Positive Reinforcement Negative Reinforcement Punishment

Page 26: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Cartoon

Page 27: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 28: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Behavior Management

These Behavior Management Strategies need to be used to teach desirable behaviors in successive approximations.

Page 29: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Rx Choices

Punishment: May make things worse – Child frightened more wetting, trouble

sleeping. Child angry and less compliant, more

distant

Page 30: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Cartoon - P.S. Mueller

Page 31: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Why Learn Development: Summary

Knowledge of Development is necessary for: Assessment Goal Setting Treatment Strategy Choices

Page 32: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 33: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 34: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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

Page 35: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Infancy

Babies are born with a set of skills Reflexes Readiness to

Orient to voice Orient to caretaker Self-management skills

Page 36: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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.

Page 37: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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

Page 38: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: InfancyTemperamental Characteristics

Activity Level Rhythmicity Approach –withdrawal Adaptability Intensity of reaction Threshold of responsiveness Quality of mood Distractibility Attention span

Page 39: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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

Page 40: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: InfancyAttachment

Attachment Reciprocal interaction in the mother

child relationship in infancy. Research done by T. Berry Brazelton

Page 41: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: InfancyCommunication

Talking with the eyes: Social referencing Drawing adult’s attention to object of

interest Negation Emotional expression

Page 42: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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”.

Page 43: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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

Page 44: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Childhood

Play as an exemplar of Piagetian theory

Page 45: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Childhood

Gender Identity exploration reflects Piagetian Cognitive Development

Page 46: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

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”

Page 47: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Childhood

Attachment and Piaget contribute to conscience development

Page 48: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Childhood

Socialization at different ages

Page 49: Issues in Developmental Disabilities Normal and Atypical Human Growth and Development Lecture Presenter: Mary Pearlman, M.D

Normal Development: Childhood

Autism and atypical developmental course