Peds: Chap. 4 Development of Occupations and Skills From Infancy Through Adolescence +

Developmental Theories and Concepts

• Neurophysiological Development:

  • The functioning of the CNS is the foundation for a child’s participation in occupations.

• Prenatal Development:

  • Prenatal care and the uterine environment are crucial for development and quality of life.

  • Key brain structures develop during prenatal periods, including cell birth, migration, differentiation, and maturation.

  • Synaptogenesis begins at 28 weeks of gestation, laying the groundwork for neural connections.

  • Neurogenesis starts within the first 2 weeks of life, marking the onset of neural development.

Developmental Theories and Concepts

• Neurophysiological Development - Postnatal Development:

  • Myelogenesis: The production of the myelin sheath around neurons, essential for efficient neural communication.

  • Cell Death and Pruning: Unused or excess cells and synapses are eliminated to refine brain function.

• Synaptic Development:

  • At 12 months, synaptic overproduction occurs, followed by pruning around age 2, refining neural networks.

• Critical Periods:

  • The first 3 years of life are crucial for development. Language exposure, sensory-motor experiences, and stimulation during this time significantly impact synaptogenesis, myelination, and neuronal activity, making it a key period for neurodevelopment.

Culture, Neurophysiological Growth, and Occupational Development:

• Cultural Priorities: A child’s developmental abilities are influenced by the cultural priorities and values of their family and community.

• Standardized Assessments: Standardized assessments may not accurately reflect the diverse cultural growth trajectories of children, as they often emphasize Western norms and developmental expectations.

• Cultural Practices: While cultural practices vary in how they support development, children are still able to achieve developmental milestones, though the timing or method of reaching them may differ.

Dynamical Systems Theory:

• Focus on Transaction: Emphasizes the interaction between a child's actions, relational flow, and their context, rather than isolating individual factors.

• Subsystem Interaction: A child’s actions result from the interaction of various subsystems, such as biological, environmental, and social factors.

• Unique Trajectories: Children exhibit unique developmental trajectories, shaped by these dynamic interactions.

• OT Treatment Goal: The goal of occupational therapy is to foster independence and transformation through motivating occupations that engage and inspire the child.

• Neuroplasticity and Occupational Development:

• Gottlieb: The fusion of the child and their environment plays a critical role in development, highlighting the interaction between the child’s biology and external factors.

• Llorens: An individual’s genetic endowment dynamically interacts with the environmental context, allowing children to grow and change through neurophysiological processing of both internal and external stimuli in response to occupational demands.

• LaCorte: The sensory-motor process of occupational physiology acts as an adaptive mechanism in central pattern generators, explaining the inherent value of occupations as purposeful activities and relationships.

• Neuroplasticity in Action: Through experience and development, new structures (cells) and function (performance) emerge, demonstrating the brain's ability to reorganize and adapt.

Occupational Science Research and Child Development:

• Occupational Perspective of Health: Research explores the different aspects of health, including doing, being, becoming, and belonging, and how these contribute to a child’s development.

• Transactional Relationship: The research focuses on the transactional relationship between the child and the contexts in which they participate, recognizing the dynamic interaction between the child and their environment.

• Bioecological View of Development: It emphasizes the bioecological view, considering the interconnected relationships between the child, caregivers, family, community, and larger geopolitical contexts that influence development.

• Occupational Perspective of Health (OPH)

• Occupational Perspective of Health (OPH)

  • Doing: 

    • Children may engage actively or passively in the performance of occupations they need to do, want to do, or are expected to do. This can promote the child’s identity as a dynamic participant in the world.

  • Being:

How one feels about participation in an occupation from a psychological or spiritual sense, and the understanding and advocacy of the self as an occupational being. The adoption of roles is important in understanding being. The inner essence of the child.

• Occupational Perspective of Health (OPH)

• • Becoming:

    • “… aims for a person's highest potential, the best possible outcome.” (Hitch, Pepin, & Stagnitti, 2014b).  Through participating in new experiences, opportunities, and challenges, children may be able to achieve goals that they set for themselves.  In becoming, the child develops into an active participant by doing self-selected occupations. 

  • Belonging: 

    • “being part of, a member of, a constituent of, associated with, connected with, included in something, feeling right and fitting in” (Wilcock & Hocking, 2015, p. 137).  Active engagement in occupations within the contexts that children participate provide opportunities for social, educational, and cultural inclusion.  Physical and social inclusions are the first step in the process of active engagement and participation. 

• Transactional Relationship Between Child and Contexts:

• • A transactional view of occupation emphasizes the relationship between the child and their environment, rather than separating individual, environmental, and occupational factors.

  • By defining the mutual, reciprocal, and multifaceted interfaces that occur between the child and their contexts, we can better understand the developmental growth and trajectory of a child’s occupational performance.

Bioecological Model of Development:

• The transaction between different contexts (e.g., family, community, environment) promotes occupational development by fostering strong relationships and adapting the environment to the child's needs.

• Key Influences on Development:

  • Individual Child: Factors like genetics, adverse childhood experiences, and resiliency impact development.

  • Caregivers: The role of caregivers, including their SES (socioeconomic status), education, and health, directly affects the child's development.

  • Environmental Availability: The availability of resources and support within the child’s environment also plays a crucial role in shaping development.

Bioecological Model of Development (continued)

• Extended Family:

  • The extended family can either provide support or act as a hindrance depending on the dynamics and resources available.

• Community:

  • Funded Child Activities: Access to sports and recreation centers helps promote development.

  • Access to Playgrounds and safe schools is essential for healthy development.

  • Public Transportation and green spaces offer opportunities for mobility and outdoor activities, contributing to overall well-being.

• Geopolitical Contexts:

  • Healthcare Policies influence the availability of medical and therapeutic resources.

  • Racism, Sexism, Ableism: Social inequalities, such as racism, sexism, and ableism, affect access to resources and opportunities for children’s development.

  • Globalism and Technology: The impact of globalism and technology can either enhance or limit children’s access to educational and developmental resources, depending on context.

Occupations and Co-Occupations for Transformational Development

• Understanding Children's Occupations:

  • Gain insight into the occupations children want to do, need to do, and are expected to do within their specific contexts (family, community, culture).

• Role of OT Practitioners:

  • Instruction: Provide guidance on how children can engage in daily tasks and develop skills.

  • Adaptation: Modify environments or tasks to ensure participation and success.

  • Empowerment: Enable children and families to take an active role in achieving developmental goals.

• Goal of Occupational Therapy:

  • The ultimate goal is the development of essential daily living skills and transformation into an occupational being that supports improved health, wellness, and quality of life.

• Engaging in desired occupations promotes occupational identity, self-efficacy, and self-determination which leads to health and wellness. As children develop a positive sense of control over their environment by engaging in occupations, they become more satisfied and involved in meaningful activities which in turn support mental and physical health and wellness. 

• Neuroplasticity refers to the creation of new neural synapses, dendritic sprouting or improved neural connections in the brain.  Multisensory activities (occupations) which require children to problem-solve and adapt in flexible natural environments promote neuroplasticity. Occupational therapists use occupations, such as play (a natural, meaningful, and whole activity) to engage children which, in turn, facilitate brain plasticity.  

• The child participates and performs in occupations based on their current skills and physical and mental health. The influence of environmental factors on a child's development is profound and influences self-identity and self-actualization. 

• Children grow and develop into competent occupational beings and full participants in the community through an interaction between the child's biologic and emotional being and his/her cultural, social, physical, virtual, and temporal contexts.

• Both internal (e.g., child's intelligence, positive affect, emotional regulation) and contextual (e.g., supportive family relationships) protective factors are needed for positive outcomes (e.g., school success and positive relationships).