Human Growth and Development

Gross motor skills develop in _____________ direction?

Cephalocaudal

Head to “tail” or from head

downward

Cephalocaudal

Fine motor skills develop in a ____________

fashion

proximodistal

Proximodistal

Center to periphery

____________ occurs during first 20 years of life, but

____________ continues throughout the lifespan

Growth

Development

A child who can walk independently for several months should not:

Be persistently tip toe walking

By 18 months a child may be developmentally delayed if they:

• Are not walking

• Not speaking 15 words

• Does not understand function of common household items

By 2 years a child may be developmentally delayed if they:

• Does not use two-word sentences

• Does not imitate actions

• Does not follow basic instructions

• Cannot push a toy with wheels

By 3 years a child may be developmentally delayed if they:

• Difficulty with stairs

• Frequent falling

• Cannot build tower of more than four blocks

• Difficulty manipulating small objects

• Cannot copy a circle

• Extreme difficulty in separation from parent or caregiver

• Does not engage in make-believe play

• Cannot communicate in short phrases

• Does not understand simple instructions

• Unclear speech

• Persistent drooling

• Little interest in other children

Risk factors for developmental delay

Genetic (Down syndrome)

Environment

Developmental delay behavioral warning signs

Inattention or unfocused

Rarely makes eye contact

Unusually frustrated with tasks

Aggressive with others

Violent on daily basis

Does not seek love

Stares into space, rocks body, or talks to self

Slide 6

Chronic neurobehavioral disorder involving inattention, impulsivity, and/or hyperactivity.

ADHD

ADHD onset?

Typically 3-4 years old

ADHD is more common in?

Males

In nonclinical settings the ratio of ADHD is?

Boy to girl 2:1

In clinical settings the ratio of ADHD is?

Boy to girl up to 9:1

Three types of ADHD

Inattentive Type

Hyperactive-Impulsive Type

Combined Type

Suspected causes of ADHD?

• Environmental

  • Low birth weight, preterm birth, low Apgar scores

  • Lead exposure

  • Chaotic/abusive households (Trauma, PTSD)

  • Maternal smoking/drinking

• Genetic predisposition (first-degree relatives are more likely)

ADHD clinical manifestations

• Difficulty with attention span frequently interrupts others

• Excessive motor activity

• Trouble completing tasks

• Sensitivity to environmental stimuli

Girls with ADHD tend to have more:

• Anxiety

• Mood swings

• Social withdrawal

• Impulsivity

• Interrupting

• Acting without thinking

Boys with ADHD tend to have more:

• Aggressiveness

• Hyperactivity

How to diagnose ADHD?

DSM-5

Detailed history questionnaires to parents & teachers, Mental health professional to evaluate and coordinate treatment, nurses, parents, & teachers work together for best outcomes of the child.

DSM-5

DSM-5 criteria

• ≥6 symptoms of inattention difficult completing tasks, hyperactivity, impulsivity

• Present for at least 6 months, onset before age 12 (sometimes noted before age 7)

• Must appear in ≥2 settings (e.g., home and school)

• Causes functional impairment