Define child development
- Development is the global impression of a child which encompasses growth, increase in understanding, acquisition of new skills and more sophisticated responses and behaviour
- Serves to endow the child with increasingly complex skills in order to function in society
What are the developmental domains?
- Gross motor and posture
- Fine motor and vision
- Language and hearing
- Social, emotional and behavioural
What tools are available for assessing childhood development?
- Developmental screening
- Standardised developmental assessment - SOGSII, Griffiths
What are the key developmental milestones at 6 weeks?
Gross motor: head level w/body in ventral suspension
Fine motor + vision: fixes and follows
H, S, L: becomes still in response to sound
S, E, B: Smiles
What is happening to the incidence of autism + ADHD?
Increasing incidence
What is abnormal development?
- Refers to slow acquisition of skills and follows 3 main patterns:
1. Slow but steady
2. Plateau
3. Regression - Delay may occur in 1 or more domain(s)
What are the key developmental milestones at 3 months?
Gross motor: holds head at 90 degrees in ventral supension
Fine motor + vision: holds an object placed in hand
H, S, L: turns to sound
S, E, B: hand regard, laughs, squeals
What are the key developmental milestones at 6 months?
Gross motor: no head lag on pull to sit; sits with support; in prone position lifts up on forearms
Fine motor + vision: palmar grasp of objects; transfers objects hand to hand
H, S, L: vocalisations
S, E, B: may finger feed self
What are the key developmental milestones at 9 months?
Gross motor: crawls; sits steadily when unsupported + pivots around
Fine motor + vision: pincer grasp; index finger approach’ bangs 2 cubes together
H, S, L: 2 syllable babble, non-specific - consonant-vowel, e.g. mama
S, E, B: waves bye bye; plays pat-a-cake; indicates wants; stranger anxiety emerging
What are the key developmental milestones at 12 months?
Gross motor: pulls to stand; cruises; may stand alone briefly; may walk alone
Fine motor + vision: puts block in cup; casts about
H, S, L: 1-2 words; imitates adults’ sounds
S, E, B: imitates activities; object permanence (objects exist when cannot be seen) established; stranger anxiety established; points to indicate wants
What are the key developmental milestones at 18 months?
Gross motor: walks well; runs
Fine motor + vision: builds tower of 2-4 cubes’ hand preference emerges
H, S, L: 6-12 words
S, E, B: uses spoon; symbolic play - “talking” on phone; domestic mimicry - “helps” in household chores
What are the key developmental milestones at 2 years?
Gross motor: kicks ball; climbs stairs 2 feet per step
Fine motor + vision: builds tower of 6-7 cubes; does circular scribbles
H, S, L: joins 2-3 words; knows some body parts; identifies objects in pictures
S, E, B: can remove some clothes
What are the key developmental milestones at 3 years?
Gross motor: stands briefly on one foot; climbs stairs 1 foot per step
Fine motor + vision: builds tower of 9 cubes; copies a circle
H, S, L: talks in short sentences that a stranger can understand
S, E, B: eats with fork + spoon; puts on clothes; may be toilet trained
Summarise the examples of developmental delay
- Cerebral palsy - disorder of mvmt and posture
- Autism spectrum disorder
- ADHD
- Learning disability - reduced intellectual functioning, delay in early milestones, dysmorphic features
What factors are considered in a history of a child with developmental delay?
- Antenatal - illnesses/infections; medications; drugs; environmental exposures
- Birth –prematurity, prolonged/complicated labour
- Postnatal - illnesses/infections; trauma
- Consanguinity – increases chances of chromosomal or autosomal recessive conditions
- Developmental milestones from parent
What are the characteristics of autism?
- Prevalence = 3-6 per 1000 live births
- Boys>girls
- Usually presents between 2-4yrs
Features:
- Impaired social interaction
- Speech and language disorder
- Imposition of routines with ritualistic and repetitive behaviour
- Comorbidities include learning and attention difficulties, and epilepsy
- Managed by intensive support for child + family
What are the diagnostic criteria for ADHD?
- Inattention
- Hyperactivity
- Impulsivity
- Lasting > 6 months
- commencing < 7 years and inconsistent with the child’s developmental level
- These features should be present in more than one setting, and cause significant social or school impairment
Management
Psychotherapy - Behavioural therapies
Family therapy
How is a child with developmental delay managed clinically?
- Investigations
- Depends on suspected cause
- E.g. cytogenetic studies
- Metabolic screen (thyroid, renal, liver and bone profiles)
- Blood ammonia and lactate
- Urine and blood organic and amino acids
- Creatine kinase
- Imaging – CT, MRI; EEG
- Nerve and muscle biopsy - Other professionals
- Referral to members of MDT helps identify problems and target input.
How is a child with developmental delay examined?
- Growth parameters – height, weight, head circumference
- Dysmorphic features
- Neurological examination and skin
- Systems examination to identify associations, syndromes
- Standardised developmental assessment – SOGSII, Griffiths
What do children with ADHD have an increased risk of?
- Conduct disorder
- Anxiety disorder
- Aggression
A significant proportion of children with ADHD will become adults with antisocial personality and there is an increased incidence of criminal behaviour and substance abuse.
What are the risk factors for ADHD?
- Boys > girls, 4:1
- Learning difficulties and developmental delay
- Neurological disorder, e.g. epilepsy, cerebral palsy
- First-degree relative with ADHD
- Family member with depression, learning disability, antisocial personality or substance abuse
How is ADHD managed?
- Psychotherapy - behavioural therapies
- Family therapy
- Drugs - if therapy is insufficient - stimulants
- Diet e.g. excluding red food colouring
What problems do children with ADHD face later in life?
- Antisocial personality
- Increased incidence of criminal behaviour + substance abuse
