Issues in Developmental Disabilities Normal and Atypical Human Growth and Development

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Issues in Developmental DisabilitiesNormal and
Atypical Human Growth and Development

• Lecture Presenter
• Mary Pearlman, M.D. 

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Why Learn Development?

• Knowledge about Development is necessary for
• Assessment
• Goal Setting
• Treatment Strategy Choices

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Assessment

• Differential Diagnosis
• Differential Diagnosis is all the possible causes
  of a set of symptoms

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Differential Diagnosis

• A Differential Diagnosis of Fever
• Flu
• Appendicitis
• Diurnal temperature variation
• Malaria
• Malingering
• Bladder infection
• Alien possession
• Just exercised
• (Partial List)

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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.

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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 cant button up. He
  just started riding a tricycle. He can copy a
  circle but not a cross.

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Differential Diagnosis (partial list)

• Attention Deficit Disorder
• Conduct Disorder
• Mental Retardation

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Assessment

• This copy of the Denver Developmental Screen Exam
  may help you with Marcs Assessment.

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DDST
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Marc 6 year old boy
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DDST
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Assessment

• IQ 100 x Mental Age / Chronologic Age
• IQ 100 x 3 yrs / 6 yrs
• IQ 50

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Assessment

• A knowledge of development allows us to diagnose
  Marc as probably having mental retardation.
• Social development is consistent with mental age.
  Marcs behavior is similar to other 3-year-olds.

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Why Learn Development?

• Knowledge of development helps with Goal Setting

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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.

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Cartoon - Real Life Adventures
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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 PJs 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?

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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 PJs. He cant manage buttons yet.

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Cartoon
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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.

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Goal Setting

• Rewards should occur soon (5 min) after Task
  Completion.
• Thanks, Marc! You were a big help.
• We have our chores done. Lets color.

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Development Treatment Strategy Choices

• Marcs bedwetting is truly a problem for the
  parents. They want him to stop.
• Is this possible given Marcs mental age?

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Rx Strategy Choices

• Development Bedwetting
• Gesell EliminationDevelopmental 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.

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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.

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Knowledge of Development

• Knowledge of Development helps with Treatment
  Strategy Choices
• Treatment can be based on
• Environmental modification
• Prevention
• Positive Reinforcement
• Negative Reinforcement
• Punishment

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Cartoon
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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.

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Behavior Management

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

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Rx Choices

• Punishment May make things worse
• Child frightened? more wetting, trouble sleeping.
  
• Child angry and less compliant, more distant

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Cartoon - P.S. Mueller
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Why Learn Development Summary

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

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Don Andersons Note

• Understanding normal or typical development is
  the primary foundation prior to the study of
  developmental disabilities and atypical or varied
  course in development.

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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.

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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

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Normal Development Infancy

• Babies are born with a set of skills
• Reflexes
• Readiness to
• Orient to voice
• Orient to caretaker
• Self-management skills

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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.

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Normal Development Infancy

• Temperament Definition
• The set of innate tendencies, or dispositions,
  that underlie and affect each persons
  interactions with people, situations and events

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Normal Development InfancyTemperamental
Characteristics

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

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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

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Normal Development InfancyAttachment

• Attachment
• Reciprocal interaction in the mother child
  relationship in infancy.
• Research done by T. Berry Brazelton

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Normal Development InfancyCommunication

• Talking with the eyes
• Social referencing
• Drawing adults attention to object of interest
• Negation
• Emotional expression

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Normal Development Infancy

• By 4 months of age
• A mother can distinguish the meaning of the
  babys different cries
• The baby can wait to feed, if mother says
  coming, baby.

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Normal Development Childhood Piagets Periods
of Cognitive Development

• 0-2yrs Sensorimotor
• 2-6yrs Preoperational
• 7-11yrs Concrete operational
• 12yrs-adult Formal operational
• Some adults age varies Post operational

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Normal Development Childhood

• Play as an exemplar of Piagetian theory

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Normal Development Childhood

• Gender Identity exploration reflects Piagetian
  Cognitive Development

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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

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Normal Development Childhood

• Attachment and Piaget contribute to conscience
  development

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Normal Development Childhood

• Socialization at different ages

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Normal Development Childhood

• Autism and atypical developmental course