Session 2: Development

Question 1

Freud Developmental Phase: Oral (3)

Answer 1

Brith-18 months

1. Mouth is primary body zone
2. Major conflict of weaning
3. Interpersonal focus on self with little differentiation from others

Question 2

Freud Developmental Phase: Anal (4)

Answer 2

18 months-3 years

1. Anus is primary body zone
2. Major conflict: toileting
3. Major activities: toilet training
4. Interpersonal focus is rebellion vs. compliance with parent wishes

Question 3

Freud Developmental Phase: Phalic (4)

Answer 3

3-6 years

1. Genital area is primary body zone
2. Genital exploration and fantasy are major activities
3. Major conflict: oedipal complex
4. Attraction to opposite sex parent with identification with same sex parents as major interpersonal focus

Question 4

Freud Developmental Phase: Latency (4)

Answer 4

6-11 years

1. No primary body zone
2. Social relationships are very important
3. No major conflict
4. Identification with same sex peers and powerful heroes

Question 5

Freud Developmental Phase: Genital (4)

Answer 5

Puberty- Adult

1. Primary body zone: genital
2. Sexual maturity and expression are major activities
3. Separation from family is the major conflict
4. Successful extrafamilial relationships

Question 6

Erikson’s Stages: Infancy (3)

Answer 6

Trust vs. Mistrust (Birth-18 months)

1. Develops when needs are met by a consistent person
2. Mistrust develops when needs are not consistently met
3. Sense of hope and optimism is outcome

Question 7

Erikson’s Stages: Toddler (3)

Answer 7

Autonomy vs. Shame and Doubt (18 months-3 years)

1. Child gains control over environment
2. Shame and doubt appear when child is forced to be dependent when the child can actually master control
3. Sense of self control and will-power

Question 8

Erikson’s Stages: 3-5 years old (4)

Answer 8

Initiative vs. Guilt (3-5 years)

1. Uses senses and power to control the body and want
2. Conscience is acquired as child starts to listen to an inner voice
3. Guilt arises when child does something in conflict with goals of other
4. Positive outcome is direction and purpose

Question 9

Erikson’s Stages: School age (4)

Answer 9

Industry vs. Inferiority (6-10 years old)

1. Child starts to complete activities
2. Becomes a rule learner and works cooperatively and competitively with others
3. Inferiority comes when more is expected than the child can achieve
4. Sense of competence is the positive outcome

Question 10

Erikson’s Stages: Adolescence (3)

Answer 10

Identity vs. Role Confusion

1. Preoccupied with physical appearance
2. Unable to solve conflicts between concept of self and society
3. Positive outcome is a sense of fidelity to values and other people

Question 11

Stella Chess’ Temperament (4)

Answer 11

1. Easy (40%): regular routines, cheerful
2. Difficult (10%): Irregular, slow to accept change, negative responder, unsatisfied
   * Set schedules to help establish regular routine
3. Slow to warm (15%): Inactive, mild low key, slow adjustment
4. Mixed (35%)

Question 12

Noam (3)

Answer 12

1. Feels early adolescence is more concerned about group cohesion and less concerned about identity
2. Younger adolescents are more susceptible to peer pressure (ex: 7th and 8th grade)
3. Development is not linear

Question 13

Easy Temperament (8)

Answer 13

1. Regularity
2. Positive approach
3. High adaptability
4. Mildly to moderately intense mood
5. Parent needs to spend separate time with child since he may be forgotten because he’s easier
6. May do what other’s want even though it’s not in best interest
7. Child is trusting
8. Teach child how to develop own rules

Question 14

Difficult Temperament (8)

Answer 14

1. Irregularity of biological functioning
2. Negative withdrawal in response to new stimuli, non adaptability
3. Slow adaptability
4. Intense mood

Parent needs to be:

5. Firm and CONSISTENT
6. Gradual repeated reinforcement of positive and negative for expected
7. Give minimum number of rules for any one time
8. Provide venue to extra emotions and energy

Question 15

Slow-to-warm Temperament (6)

Answer 15

1. Negative mood of mild intensity
2. Slow adaptability to new situations

Parent needs to be:

3. Maintain calm as anger accelerates for child’s reaction
4. Do not compete with this child
5. Repetition is needed
6. Maintain consistent rules

Question 16

Goodness of fit

Answer 16

Central is understanding how child’s temperament affects the family
*Impact of temperament on child’s adaptive functioning

Good fit: child’s temperament fits with parental goals, standards and values that affects the nature of the parent’s responses to the child

Poor fit: difference between parental expectation and the child’s temperament

Question 17

Piaget’s Sensorimotor Stage

Answer 17

Birth-2 years

*No thinking structures

Question 18

Piaget’s PreOperational Stage

Answer 18

2-7 years old

Develop language skills, cognitive structures - prelogical

Question 19

Piaget’s Concrete Operational Stage (4)

Answer 19

7 years old - Adolescence

1. Begins to question life
2. Solves problems but haphazardly
3. Mass, number, linear time
4. Deductive reasoning

Question 20

Piaget’s Formal Operational Stage

Answer 20

Adolescence and onward

1. Capable of sophisticated logical thought
2. Can think both abstract and hypothetically
3. Solves problems using the logic of combinations

Question 21

Medical/Biological Neonatal Risk Category for Developmental Delay (7)

Answer 21

1. Birth weight less than 1501 grams
2. Gestational age less than 35 weeks
3. Central nervous system insult or abnormality (including neonatal seizures intracranial hemorrhage, need for
   ventilator support for more than 48 hours, birth trauma)
4. Congenital malformations
5. Asphyxia (Apgar score of three or less at five minutes)
6. Abnormalities in muscle tone, such as hyper- or hypotonicity
7. Hyperbilirubinemia (> 20 mg/dl)

Question 22

MEDICAL/BIOLOGICAL NEONATAL RISK CRITERIA FOR DEVELOPMENTAL DELAY 2 (5)

Answer 22

1. Hypoglycemia (serum glucose under 20
   mg/dl)
2. Growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem)
3. Presence of Inborn Metabolic Disorder (IMD)
4. Perinatally- or Congenitally transmitted infection (e.g., HIV, hepatitis B, syphilis)
5. 10 or more days hospitalization in a Neonatal Intensive Care Unit (NICU)

Question 23

MEDICAL/BIOLOGICAL NEONATAL RISK CRITERIA FOR DEVELOPMENTAL DELAY 3 (6)

Answer 23

1. Maternal prenatal alcohol abuse
2. Maternal prenatal abuse of illicit substances
3. Prenatal exposure to therapeutic drugs with known potential development implications (e.g., psychotropic medications, anticonvulsant, antineoplastic)
4. Maternal PKU
5. Suspected hearing impairment (e.g., familial history of hearing impairment or loss; suspicion based on gross screening measures)
6. Suspected vision impairment (suspicion based on gross screening measures)

Question 24

MEDICAL/BIOLOGICAL NEONATAL RISK CRITERIA FOR DEVELOPMENTAL DELAY 4 (6)

Answer 24

1. Parental or caregiver concern about developmental status
2. Suspect score on standardized developmental or sensory screening test
3. Serious illness or traumatic injury with implications
   for central nervous system development and requiring hospitalization in a pediatric intensive care unit for ten or more days
4. Elevated venous blood lead levels (above 19 mcg/dl)
5. Growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia)
6. Chronicity of serous otitis media (continuous for a minimum of three months)

Question 25

Kohlberg: birth-18 months

Answer 25

Amoral Moral reasoning cannot begin until the child reaches a certain level of cognitive development

Question 26

Kohlberg: 18 months-9 years

Answer 26

Preconventional: Obedience and Punishment Orient 1. Behavioral decision made on fear of punishment 2. Good and bad defined in terms of physical consequences

Question 27

Kohlberg: Preconventional Instrumental Relativist Orientation

Answer 27

3-6 years old Behavioral decisions made based on concern of self and egocentric satisfaction, although may occasionally do something to please another if there are advantages for self

Question 28

Kohlberg: Conventional Interpersonal Concordance Orient

Answer 28

6-11 years old Behavioral decisions based on desire to gain approval from others, judgments made based on intentions

Question 29

Kohlberg: Conventional Law and Order Orientation

Answer 29

6-11 years old Behavioral decisions based on laws and respect for authority, laws take precedence over personal wishes

Question 30

Kohlberg: Postconventional Social Contract Legalist

Answer 30

11-18 years Morality based on personal values, people must work to change laws that are not moral or just

Question 31

Kohlberg: Postconventional Universal Ethical Principle

Answer 31

11-18 years Morality based on internalized ideals and conscience rather than social rules

Question 32

Key Principles about Development (10)

Answer 32

1. Growth and development are orderly and sequential 2. Each child sets their own pace 3. Growth is cephalocaudal first then proximodistal 4. Behaviors become increasingly integrated 5. Environmental, social, genetics, nutrition play a role 6. Responses to stimuli go from generalized reflexes involving the entire body to discrete voluntary actions 7. Language delays are the most common 8. Growth milestones are predictable 9. Receptive and expressive language are different 10. Skills are built on each other and are rarely skipped

Question 33

Developmental Surveillance (7)

Answer 33

1. Monitoring a child's development over time; an ongoing process of accessing a child's developmental status at each well child visit (Does the child look developmentally on target? Use visual assessments, etc.; not a screening tool) 2. Take a thorough history 3. Review developmental milestones 4. Make skilled observations of child during each visit 5. Elicit parental concerns 6. Observe child's rate of development, temperament style, emotional adjustment 7. Access a child's current developmental function compared with a standardized sample of children of same age

Question 34

Developmental Screening Tools (3)

Answer 34

1. Minnesota Child Development Inventories 2. Ages and Stages Questionnaire (formerly infant monitoring system) 3. Parent's Evaluations of Developmental Status (PEDS)

Question 35

Moro Reflex

Answer 35

Eliciting the reflex involves sudden drop of the head when the infant is supine. The full response involves extension of the arms, “fanning” of the fingers, and then upper extremity flexion followed by a cry Emergence: 37 weeks gestation (present at birth) Age of disappearance: 4 months

Question 36

Tonic Neck Reflex

Answer 36

If the head is directed to one side, either by passive turning or inducing the baby to follow an object to that side, tone in the extensor muscles increases on that side in the flexor muscles on the opposite side Emergence: 35 weeks gestation, peaks at 4-6 weeks of life Disappears: 4-6 months

Question 37

Palmar Grasp

Answer 37

Age of emergence: 28 weeks gestation Disappearance: 3-6 months

Question 38

Placing, Stepping Reflex

Answer 38

Age of emergence: 37 weeks gestation Disappearance: 6-8 weeks

Question 39

Ankle clonus, up to 5-10 beats reflex

Answer 39

When you flex the ankle upwards, there are little reflexive beats; up to 5-10 beats is normal in first month of life but abnormal afterwards (would be a sign of hypertonicity) Age of emergence: 33-35 weeks gestation Age of disappearance: 1 month

Question 40

Pupillary Response

Answer 40

Age of emergence: 32 weeks gestation Never disappears!

Question 41

Babinski reflex

Answer 41

Run the thumb down the medial surface of the tibia and the big toe fans and extends Age of disappearance: positive until starting to walk

Question 42

Physical length growth in first year of life?

Answer 42

9-11 inches

Question 43

Head circumference growth (3)

Answer 43

1. Birth-3 months: 2cm/month 2. 4-6 months: 1cm/month 3. 6-12 months: 0.5cm/month

Question 44

When does posterior fontanel close?

Answer 44

2 months

Question 45

When does anterior fontanel close?

Answer 45

18 months-2 years

Question 46

Weight growth

Answer 46

1. Birth-6 months: one ounce per day 2. 6 months-12 months: 1/2 ounce per day 3. Birth weight is quadrupled by end of the 2nd year 4. From 2-9 years old: gain 5 lbs per year * Toddlers lose appetite because they don't have to gain weight

Question 47

Length growth

Answer 47

1. 5 inches in 2nd year 2. 3-4 inches in 3rd year 3. 2-3 inches per year post this

Question 48

How many teeth by 2.5 years old?

Answer 48

20 teeth