Child and Adolescent Midterm from "study guide"

Prenatal Period

Conception to birth

Infancy Period

0-1

Toddler Period

1-3

Preschool Period

3-6

Middle Childhood Period

6-12

Adolescent Period

12-18

Early adulthood

18-40

Middle Adulthood

40-65

Late Adulthood

65+

Domains of human performance

1. Cognitive Domain

2. Affective Domain

3. Psychomotor Domain

Bathing is dependent until

3 bc of drowning risk

Principles of Development

Lifelong
Sequential and predictable
Highly variable within and between children
Multidimensional and directional
Influenced by multiple, interacting forces (e.g. biological, social, cultural, etc.)
Occurs in several domains at the same time
Some skills advance while others decline
Dynamic Systems

Principles of development (2)

Directional

• Cephalocaudal

• Proximal to distal

• Gross > Fine motor

• Undifferentitated → Specific

Kinesiological

• Antigravity Movements

• Mobility and Stability

• Asymmetry to symmetry to controlled asymmetry

• Rotation/dissociation

9 Areas of Occupation

ADLs, IADLS, Work, Play, Leisure, Social Participation, Health Management, Rest and Sleep, Education

Occupational Continuum ex with eating

Eating → Feeding → Mealtime Prep

Dependent or co-dependent on food, drink, and timing of meal → Semi-independent with food, drink, and timing of meal → Independent

Occupational Continuum ex with Personal Hygiene

Natal

Prenatal

Perinatal

Postnatal or postpartum

Natal: Something related to birth, related to term “native”

Prenatal: Before birth

Perinatal: during birth

Postnatal or postpartum: after birth

Periods of Prenatal Development

Germinal

• 2 weeks from conception- zygote implants into uterine wall
• Circulatory system starting

Periods of Prenatal Development

Embryonic

• 3-8 weeks
• All major body structures formed
• Most susceptible period
• Develop proximodistal and cephalocaudal

Periods of Prenatal Development

Fetal

• 9 weeks to birth
• Complex structural changes
• Weight gain
• 28 weeks: most neonatal reflexes developed
• 32-36 weeks: sucking reflex

Environment in Utero

• Sensory Considerations
• Temperature
• Movement
• Sounds
• Positioning
• Vision

Genetics in Development

Sex linked traits: Hemophilia, Color blindness, MD, Fragile X

Incomplete Dominance: Tay-Sachs

Polygenetic Inheritance: Parkinsons, Diabtes, Autsism, Spina Bifidia, Arthritis

Chromosomal Abnormalities: Down Syndrome, Cri du chat, turner syndrome

Gene-linked Abnormalities: PKU, Huntingtons, CF

Genetic Mutations: Drarfism, ostogeneis imperfecta, limb deformites, Cleft

Changes at Birth

Bombarded by stimuli!
• From water to land
• Fighting against gravity
• Changes in body functions
• Eating
• Breathing
• Voiding
All with an immature CNS!

Any agent that may cause damage during the prenatal period

Causes greatest structural abnormalities during the embryonic period

AND EXAMPLES

Teratogens

Examples
• Alcohol
• Drugs (can be illicit but also certain medications)
• Viruses: CMV, Zika, Varicella, STIs

Type and Severity of teratogens is directly related to (some ex)

• Type of agent
• Dose of agent
• Time of exposure
• Duration of exposure
• Maternal and fetal susceptibility
• Teratogens account for 4-5% of congenital disorders.

• Examples of related diagnoses
• Fetal Alcohol Spectrum Disorders
• Premature birth/fetal growth restriction
• Cognitive Impairment/Neurological issues
• Neonatal Abstinence Syndrome
• Cleft-lip/palate
• Anencephaly

Non-Modifiable Risk Factors for Preterm

Prior Preterm birth

African American Race

Age less 18 or above 40

Poor Nutrition/Low pre-pregnancy wt

Low SES

Cervical Injury

Uterine anomaly

Premature cervical dilation Less 2 cm

Over distended Uterus

Vaginal Bleeding

Excessive uterine act

Modifiable Risk Factors for Preterm

Cig smoking

Substance Abuse

Absent prenatal care

Short interpreg intervals

Anemia

Bacteriuria/UTI

Genital Infection

Strenuous work or High personal stress

Prematurity Trends

• Between 1996 and 2006, preterm birth rose more than 20%
• Mostly due to the rise in late preterm deliveries
• Half of all preterm births involve Cesareans
• Decrease in preterm births from 2007 to 2014
• Mostly due to a decrease in the number of teen and young mother births
• Increase from 2014-2017
• The rate of preterm birth was double among black women versus white
women
• Covid has demonstrated a positive correlation with increase in preterm birth
rates

Prematurity outcomes Past and Present

• Past: Major cause of death
• Now: Greater disability and greater
range of disability
Developmental delays
• Permanent medical conditions
• Slowed development
• Sensory Processing Difficulties
• Academic achievement challenges
• IQ

When is most susceptible period for baby

1st trimester

When will a car accident affect the baby most

3rd trimester

Development and Labor/Birth

• Baby's development signals body to go into labor (unless preterm)
• Labor supports bacterial/digestive development of the baby
• Baby's body structure is designed to support labor
• Anatomical structures
• Reflexes
• Breastfeeding after birth
• Birth Options and Labor Interventions can impact maternal and baby health outcomes

Full Term Birth

37-42 weeks

Size 19-21”

Weight avg: 7.6 lbs

Prematurity Complications

• Hypoxia
• Low birth weight
• Respiratory Distress Syndrome
• Apnea
• Poor temperature regulation
• Intraventricular hemorrhage
• Cardiac conditions
• Chronic lung disease
• Failure to thrive
• Retinopathy of Prematurity (ROP)
• Nutritional difficulties

Birthing Complications

• Perinatal complications
• Brachial plexus injury
• Hypoxic-Eschemic Encepalopathy (HIE)
• Cerebral palsy
• Brain Bleed or Cephalahematoma
• Others
• Birth defects
• Prematurity

Calculated Age and Adjusted Age

Pre-term birth age is corrected until the child is 2 yo

Todays date/Date of eval

SUBTRACT Date of birth

EQUALS = Calculated age

Adjusted age formula

Calculated age

SUBTRACT Weeks premature

EQUALS = Adjusted age

Behaviorism BF Skinner and Watson

Concerns self with observable and measurebale behaviors,

Learning occurs through classical and operant conditioning

Social Learning Theory

Attention → Retention → Motor Reproduction → Motivation

Stim Focus → Rehearse Encode → Pract Feedback → Reward Reinforce

Ecological Systems Theory

Chronosystem: Broad, Events and transitions over a life time (divorce and remarriage and changes in political and social context)

Macrosystem: Wider ideological and cultural context, (Economic Structure, Laws, Culture)

Exosystem: Indirect but powerful influence (Media, local policies, local amenities)

Mesosystem: The interactions between things in microsystem

Microsystem: Immediate enviornment (Peers, family, religon)

Individual

Neuromaturational Theory
Arnold Gesell

– CNS maturation is primary agent for development and change in an individual
– Motor skills develop based on CNS maturation
– Higher cortical levels control lower cortical levels
– Higher level skills are contingent upon development of lower level skills
– Movement progresses from reflex patterns to coordinated motor control
– Rate and sequence of motor skills is consistent

Dynamical Systems Theory
Esther Thelen

– Development can only be understood as the multiple, mutual, and continuous interaction of all the levels of the developing system, from the molecular to the cultural.
– Motor skills develop based on an interaction between multiple systems:
– Body
– Environment
– Task

Developmental Theories

Cognitive-Developmental Theory (Jean Piaget)

– Showed children think in different ways than adults
– Cognitive development is a reorganization of mental processes rather as a result
of nature and nurture
– Schemas are the basic building blocks of intelligent behavior

– Sociocultural Theory (Lev Vygotsky)

– Zone of proximal development
– Scaffolding

Hierarchy of Needs
Abraham Maslow

– Belief that lower level needs need to be met first to enable higher level performance
– People act according to the priority of needs across the life span
– Goal is self-actualization

Psychosocial Theory

Erik Erikson

– 8 psychosocial stages across the lifespan

– Each stage contains a stage-specific conflict

– Differences in personality can be explained by the way a conflict was or was not resolved

Moral Stages of Development
Lawrence Kohlberg

– Extended Piaget’s theory
– Moral development occurs across the lifespan
– Based theory on interviews with children
– Does moral reasoning lead to moral behavior?

Temperament Theory
Stella Chess and Alexander Thomas

Temperament Traits
1. Activity level
2. Distractibility
3. Intensity of reaction
4. Biological rhythmicity
5. Threshold of responsiveness
6. Approach/withdrawal
7. Adaptability
8. Persistence/attention span

Mood Types
– Easy babies
– Difficult babies
– Slow to warm up babies
– Others not clearly defined

Theory of Attachment

John Bowlby and Mary Ainsworth

Considers the importance of the child’s relationship with the mother in terms of social, emotional, and cognitive development

1) Secure attachment

2) Ambivalent attachment

3) Avoidant attachment

4) Disorganized/disoriented attachment

Fine Motor Development

• Hand movement and hands to mouth in utero

• Hands fisted at birth with reflexive grasp

• Hands open more by 3 months and functional grasps emerging around 4 months

• Ulnar to radial progression

• Pincer grasp appears around 10 months and becomes more refined,

preparing for tool use

• 12-18 months: grasping and manipulating coloring utensils

• 24-30 months: separation of ulnar and radial sides of hand

• By 3yo: complementary hand use

Gross Motor Development 1-3 years

• Walking/navigating surface changes (12-18 months)
• Squatting (12-18 months, earlier when holding on)
• Climbing
• Steps
• Creeps (12-18 months)
• Non-reciprocal (24-30 months)
• Reciprocal (30-36 months)
• Running (18-24 months)
• Jumping
• Jumps off small obstacles (24-30 months)
• Jumps over objects with 2 feet (30-36 months)
• Hops on one foot (30-36 months)

12-15 months

2-3 years

24-30 months

12-15 months - Palmar Supinate Grasp

2-3 years - Digital Pronate Grasp

24-30 months - Snips

Physical vs Psychomotor Devlopment

**Physical - Actually growing

Psychomotor- being able to move and do things

Cognitive domain: Piaget Sensorimotor Stage (0-2y)

• Initially dominated by reflexes
• "Thinking" is expressed via motor action
• Sensorimotor actions occur by "accident"
• Get repeated for pleasure or because of specific effect
• Explore the environment and begins to imitate others
• Interactions with objects are sought and
exploration of how to use them
• Mental representation begins
• Pretend play

Cognitive Domain Bandura

Multidomain Theory: Cognitive, Behavioral, Social

Neonate Vision

• Legally blind

• High contrast

• Attracted to moving stimuli

• Preference for faces

• 8-10" range of focus

• Eyes and head move together

Synaptic Pruning

Process of eliminating of unused Nerons

Purpose is to inc efficiency of neural connections

Vision Development

• Begin moving eyes independently from head by 2-4

months

• Begin tracking & visually triggered reaching by 3 months

• Depth perception begins to develop 3-5 months

• Color vision established around 5 months

• Visually guided reaching around 6 months

• Crawling helps develop good eye, hand, foot coordination

Growth slows after..

first year

By 2: half adult height

By 3: Head size 90% adult size

Persistence of a reflex beyond age range

Retained

2 types of reflexes

• Primitive Reflexes
• Function to protect and nourish for survival
• Develop in utero and are present at birth for full
term babies
• STNR, ATNR, Tonic Labyrinthine, Neck Righting,
Landau, Palmar, Suck, Moro, Startle, Plantar
• Postural Reflexes
• Function to provide “practice” for future
voluntary movements (motor development)
• Emerge after birth, replacing primitive reflexes
over time
• Head/Body Righting, Step, Equilibrium reactions

Vision Development 9m-1y

• Refinement of eye-hand coordination

• Vision motivates movement

• Alert to new people and surroundings

• Knows familiar and unfamiliar people

• Watching and imitating faces

Vision Development 1-3 y

• Increasing complexity of eye-hand coordination

• By 2: myelination of optic nerve has occurred;

normal acuity

• Matching objects by a single characteristic

• By 3: retinal tissue is mature, complete basic

formboard puzzles, forming some prewriting

strokes

How Motor Skills are the Foundation for Feeding Solids

Good head and neck control/Able to sit unassisted
Loss of tongue thrust reflex
Able to bring hands and toys to mouth
Developing a pincer grasp
Visual Interest in food and mealtime routines
Imitating motor patterns with mouth

Occupational Continuum personal Hygiene example

Developmental considerations:
• Washing hands less complex than drying hands
• Nighttime bowel control, daytime bowel control before daytime bladder control and nighttime bladder control
By 12 months
• May indicate when diaper needs changing
By 18-24 months
• Holds out hands to be washed, rubs hands together
• Opens mouth for teeth to be brushed
By 24 months
• Shows interest in potty training
• Flushes toilet independently

Co-occupations

Occupations done with another person

Cognitive Development w language

Infants communicate by crying
1-2 months: cooing, gurgling, vocalizing
5-6 months: babbling begins
6 months: early object permanence
7-9 months: clear vowel- consonant sound (da- da); manipulating
environment purposefully
11-12 months: first true word, object permanence most established, cause
and effect more mature

12-18 months Cog Develop

Mastery of object permeance, joint attention imitated by child, knows some body parts

18-24 months cog Develop

deferred imitation, increased rate of word learning, putting words together

Cog Develop 24-36 months

• Able to attend to more than one thing at a time
• Memorizes favorite songs and rhymes
• Very interested in how things work
• Able to remember events from the past
• Knows where you are going by landmarks
• Knows at least 1 color
• Demonstrates simple problem-solving skills

Language Develop 24-36 months Receptive and expressive

Receptive
• Understands
• 2-step directions
• Simple concepts/opposites (in/out,
hot/cold, stop/go)
• Why questions
• New words quickly
Expressive
• Uses 2–3-word phrases
• At least 50% of speech is
understood by caregiver
• Has a word for almost
everything
• Uses words like in, on, under

Early signs of Autism

• Very little eye contact
• Does not respond to caregiver's smile
• Does not point to objects/events to get caregiver's attention
• Does not say single words by 16 months
• Does not start a conversation or cannot continue it
• Rocks, spins, sways, walks on toes for long periods of time
• Over or under responsive to sensory stimuli
• Difficulty with transitions

Object Permanence Definition

Understanding of toys in basket, parents at work, biscuits in jars continue to exist even if they are not visible

SUID Prevention and Plagiocephaly

 Increased incidence of:
 Positional plagiocephaly
 Torticollis
 Delayed gross motor development

Moro Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Protective Response, perceived danger, protects vital organs, fight or flight

Appears: Emerges in utero, fully present at birth Integrates: 2-4 months

Stimuli: Sudden Change in sensory stimuli (visual, auditory, tactile, or vestibular)

Response: Abduction and EXT of arms followed by flexion pattern

Rooting Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Supports feeding, baby turns head towards bottle/breast

Appears: Birth Integrates: 3-6 months

Stimuli: Touch to corner of mouth and cheek

Response: Baby turns towards that touch (presumably breast or caregiver with bottle)

Suck Swallow Breathe Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Supports breathing while eating without choking

Appears:32-37 weeks in utero

Integrates: 2-5 months

Stimuli: Nipple placed in mouth

Response: Baby begins sucking, 1:1:1 ratio of suck, swallow, then breath with airway protected

Palmar reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Protective to help baby hold onto parent, assist with grasp development

Appears: birth Integrates: 4-6 months

Stimuli: Pressure on infants palm

Response: Grasp Object in palm

Plantar Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Protective to help baby hold onto parent, assist with gross motor developmental sequence Appears: Birth Integrates: 9 months

Stimuli: Pressure to the ball of the foot under toes Response: Flexion and adduction of toes

Asymmetrical Tonic Neck Reflex - ATNR

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Assist baby to move through birth canal and helps develop cross patterns movements

Appears: 18-20 weeks in utero

Integrates: 6 months

Stimuli: Rotation of head to one side

Response: “fencer pose: ext. of limbs on face side; flex of occipital side

Symmetric Tonic Neck Reflex - STNR

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Separate movements of upper and lower body Foundational for crawling

Appears: 4-6 months

Integrates: 9-12 months

Stimuli: Flexion or extension of the head

Response: Head flex- arms flex and legs extend

Head extend - arms extend and legs flex

Steeping Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Allows baby to crawl to breast after birth Appears: 28 weeks in utero

Integrates: 2 months

Stimuli: Held upright or foot touching solid surface Response: Baby appears to march or take steps

Spinal Galant Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Assist baby to move through birth canal, foundational to crawling and creeping

Appears: 20 weeks in utero

Integrates: 3-9 months

Stimuli: Tactile input on either side of spine

Response: Trunk curves towards side that was stimulated

Tonic Labrinthine Reflex (TLR)

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Foundational for head and postural stability Appears: emerges in around 12 weeks in utero fully present at birth

Integrates: 4 -6 months

Stimuli: Placed in prone or supine position'

Response: Prone- overall flexion pattern

Supine- Overall extension patter

Landau *Secondary reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Necessary for postural development, increases breathing safely in prone

Appears: 4-6 months as TRL intergrates

Integrates: 12-24 months

Stimuli: Baby in prone on flat surface or held Response: Superman pattern with extension in limbs

Head/Optical Righting Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Protective for maintaining airway and establishing equilibrium/balance

Appears: birth - 2 month

Integrates: Persist

Stimuli: Tilt body in any direction

Response: Head orients to remain in upright position

Protective Extension Reflex

Purpose, Appears, Integrates, Stimuli, Response

Purpose: Protective during loss of balance/falls, foundational for equilibrium

Appears: Down - 4mo, Forward 6-7 months, Sideways 7mo, Back 9-10 months

Integrates: Persists

Stimuli: Displace center of gravity outside base of support

Response: Arms reach in the direction the body was displaced in order to stop fall and protect structures

Affective Domain Erikson: Stage 1: Trust vs. Mistrust (0-18 months)

• Child learns "Can I trust the people around me?"
• Based on how fast needs are met when communicated (crying)
• Important event: feeding
• Feeling safe and secure
• Providing affection and comfort is essential

Affective Domain Erikson: Stage 2: Autonomy vs. Shame & Doubt (18 months-3 years)

• Child learned increased independence with supportive encouragement
• Child wants to experiment and “do it myself”
• Increased independence with lead to increased self-esteem
• If child is not permitted to explore independence, they will develop feelings of embarrassment
and doubt

Aff Domain Middle Infancy (4-6 months)

• Early play
• Shows delight
• Laughs
• Reciprocal social interaction
• Pattycake and peek a boo
• Clear preference for caregivers
• Begin to differentiate the emotions of others even if they don't understand them yet

Affective Domain Early Infancy (0-3 months)• First smile (2-3)

• Visual tracking not across midline (B)
• Cries to communicate distress (B-3)
• Temperament stable
• Calms to human voice and face
• Tells difference between mother and
stranger (1)
• Visual tracking across midline (3)

Affective Development
Late Infancy (7-9 months) & Transitional Infancy (10-12 months)

Late Infancy (7-9 months)
• Shows anger and fear (7-9)
• Caregiver attachment
• Separation protests; Protests if
caregiver leaves (7)
• Initiates social interaction
• Emotional beings (9)
Transitional Infancy (10-12 months)
• Shows clear attachment
style
• Stranger/Separation anxiety
• Greets others and shows
regular affection

Affective Development
1-3 years old

• Safe and secure in loving relationships
• Loves being the center of attention
• Recognize self in the mirror or photograph and
makes faces
• Protests and says "No!"
• Likes to do things without help
• Has trouble sharing, may hit, push, and grab to keep
toys
• Watches and copies others
• Shows a wide range of emotions
• Begins to label emotions on self and others
• Shows affection and concern for others

4 types of Parents

Authorative: Clear expectations, definite rules, supportive

Authoritarian: High Expectations, Disciplined, Unsupportive

Permissive: Low expectations, excessive responsiveness

Uninvolved: No boundaries, Little Support

Sensory factors that impact Infant and toddler regulation

• Proprioception
• Temperature
• Interoception: fatigue, hunger, thirst, feeling wet or soiled, feeling sick
• OVERSTIMULATION (CAN BE IN ANY SENSORY SYSTEM)
• Lack of stimulation can lead to boredom and increase need for adult
attention/interaction

4 different play

Unoccupied Play

Solitary Play

Onlooker Play

Parallel Play

Infancy Occupations and Co-occupations

 Eating
 Beginning self-feeding
 Sleep
 Sensorimotor (exploratory) play

Toddler Occupations and Co-occupations

 Eating & Self-feeding
 Sleep and rest
 Beginning participation in dressing
 Beginning hygiene
 Beginning social participation
 Beginning education
 Play

Average Attention Span of children

Double their age (start range) and add age (end range)

4 years old: 8-12 mins

APA sleep reccomend

Supine for sleep “Back to sleep”
 Firm, flat, non-inclined sleep surface
 Feeding of human milk
 Sleep in caregiver’s room, close to the bed, but a separate sleep surface for at
least the first 6 months
 No soft objects: toys, blankets, pillows, bumpers
 Offer a pacifier at nap and bedtime
 Avoid overheating and head covering

“specific, automatic behaviors performed repeatedly, relatively automatically, and with little variation”

Habits