2. Development
Characterised by processes in which each individual uniquely adapts
and integrates his or her own nature with the opportunities and
limitations of his or her experience across time
3. Definition of Child Development
• Development is a series of coordinated, progressive changes
occurring from conception to till the end
Or
• Is a series of qualitative, progressive, and coherent changes that
indicate the maturation of the individual
Or
• Average or “on-time” growth based on the attainment of specific
physical, cognitive, linguistic, social-emotional, and behavioral
milestones across specific stages.
4. Principles of Development
Principles Implications for clinical assessment
Continuous Are there any arrested or incomplete or delayed or deviant behaviours?
Predictable Given a current skill, what is the next skill?
Product of maturation and learning Family history of developmental problems
Genetic disorders (3-Generation genogram)
Stimulating environment
Maternal sensitivity
Socio-ecological agencies
Each stage characterized by specific tasks Are the tasks adequate?
Pre-requisites are there?
Follows specific principles:
Cephalo-caudal law Proximo-distal law
If higher items are passed, lower items are passed (exceptions- CP/Pure
neurological or sensory-motor conditions)
Universal yet individualistic Norms are not necessarily the ‘norm’
Individual variations are possible
Different areas are inter related If one area is affected, assess related areas
7. Developmental Transactional Ecological Model
(Bronfenbrenner, 1979; Sameroff, 2000)
Child’s behaviour at any point in time is a product of reciprocal
transactions among the
• child’s characteristics (genetic/biological/physical; cognitive/linguistic and socio-
emotional competencies)
• and the caregiving environment (dynamic interrelationships among child behaviour,
caregiver responses to such behaviour and the dyadic relationship) and the
• broader ecological context (multiple levels of social organisation, including family,
neighbourhood and child care)
14. Domains of Nurturing Care for children to reach
their Developmental Potential (Lancet, 2016)
Domains
of
Nurturing
care
Health
Nutrition
Responsive
Caregiving
Safety and
Security
Early
Learning
15. Play
• Contributes to cognitive and
social skills
• Improves memory, sustained
attention, logical reasoning,
language, imagination,
creativity, understanding of
emotions, the ability to reflect
on one’s own thinking and
taking the perspective of
another (Bergen and Mauer,
2000)
How to enhance play?
• Provide safe space
• Encourage without controlling it
• Offer both realistic and materials with no
clear purpose
• Ensure children have rich real world
experiences
• Help solve social conflicts constructively
16. Delays and Disorders
Any deviation (e.g. ASD) or delay (e.g. IDD) in the typical development expected of age in a given socio-cultural context is called
developmental disorder
They delay or impair physical, cognitive, and/or psychological development of children.
Types
Global Vs. Specific
Permanent Vs. Transient
17. Classification of neurodevelopmental
disorders – DSM-5 or ICD-11
• Key features
Onset that is invariably during infancy or childhood
Impairment or delay in the development of functions that are
strongly related to the biological maturation of the CNS
Steady course that not involve remissions or relapses
Impairments tend to lessen as children grow older, but deficits
may continue into adult life
18. Other features of neurodevelopmental
disorders
Impairment in a
development-
based skill
Impairment
in
functioning
Deviant
functioning
19. Contd…
• Multi-factorial in origin
• Tend to improve with age but may be associated with disordered
functioning that extends into adulthood
• Marked male preponderance
• Neuropsychological deficits of various kinds
• Comorbidity with other neurodevelopmental disorders is high
21. According to DSM-5
Intellectual Disability/ Intellectual Developmental Disorder
Communication Disorders
Autism Spectrum Disorders
Attention-Deficit/Hyperactivity Disorder
Specific Learning Disorder
Motor Disorders
Other neurodevelopmental disorders
22. Intellectual Disability
• Deficits in intellectual and adaptive functioning in conceptual, social
and practical domains
• Severity levels – Mild, Moderate, Severe, Profound
• Global Developmental Delay
• Unspecified Intellectual Disability
24. Autism Spectrum Disorder
A. Persistent difficulties in social communication and social
interaction across multiple contexts
B. Restricted, repetitive patterns of behaviour, interests, or
activities
Severity levels: Level 1, 2,3
Specifiers
With or without accompanying intellectual impairment
With or without underlying language impairment
Associated with a known medical or genetic condition or
environmental factor
Associated with another neurodevelopmental, mental or
behavioural disorder
With catatonia
25. Attention-Deficit/Hyperactivity Disorder
• Inattention and/or hyperactivity-impulsivity that interferes with
functioning or development
• Prior to the age of 12 years
• Two or more settings
• Symptoms interfere with the quality of social, academic or occupational
functioning
• Specifiers: Combined; Predominantly inattentive; predominantly
hyperactive-impulsive presentation
• In partial remission
• Current severity: Mild; Moderate; Severe
26. Specific Learning Disorder
Specifiers
• With impairment in reading
• With impairment in written expression
• With impairment in mathematics
Level of severity
• Mild
• Moderate
• Severe
28. Concept of maturational lag
• Huge individual differences in the timing of all developmental
functions
• “Developmental catch-up”
• Developmental catch up does not occur in everyone although gains
are made with age
• Normalisation of cortical thickness over time in children with ADHD
who had a good outcome (Shaw et al 2006,2007)
29. Explanatory models of concurrent
comorbidity (Caron & Rutter, 1991)
RISK FACTORS
• Genetic
• Stochastic
• Epigenetic
• Early
environmental
NEURAL &
BIOLOGICAL
CHARACTERISTICS
• Biological
processes
• Brain structure
& function
• Neural
development
• Cognitive
impairment
PHENOTYPES
ID
ASD
ADHD
Communication
Disorders
SLD
Tic disorders
36. Assessment
• Developmental history
• Medical history including prenatal and perinatal history, identification
of any past or current health conditions, family history to identify
genetic disorders
• Physical examination – including those for congenital anomalies, HC,
growth evaluation
• Individual disorder specific assessments
• Other assessments – hearing, vision, cognitive, sensory, motor
coordination, psychological including a skill and need based profile
38. Management
• NDD are lifelong conditions
• They almost always improve with time and intervention
• Comorbidity is the rule rather than the exception, both with other NDD and with
other psychiatric disorders
• Need for careful assessment and plan of management
• Multidisciplinary inputs
• Need regular follow up
• Parenting – needs to be addressed both from the parents and the child’s
perspective as they are our main resource
• Treatment needs to include centre based and community based resources
• Treatment including supportive social contexts needs to continue into adulthood
39. In conclusion..
• Child development is predictable but complex
• A number of interrelated factors have a role
• Young children need nurturing care from the start
• Multi-sectoral interventions that target multiple risks to development
that take care of both the child and the caregiver key with health
services as an entry point
• Early identification and intervention in NDD is vital
• Need long-term support
• Multi-disciplinary inputs with multi-sectoral coordination key
Childhood development is a maturational process resulting in an ordered progression of perceptual, motor, cognitive, language, socio-emotional, and selfregulation skills. Thus, the acquisition of skills through the life-cycle builds on the foundational capacities established in early childhood
Infancy – Obedience/punishment (Avoiding punishment), Preschool – Self-interest (Aiming at reward), School age- Conformity and interpersonal accord and Authority and Social Order(good Boy/Girl and maintaining social order), Teens – Social Contract(Justice and spirit of the Law), Adulthood – Universal principles (Morality is based on principles that transcend mutual benefit)
Attachment is a specific and circumscribed aspect of the relationship between a parent and a child that is involved in making a child feel safe, secure and protected. Ethological theory of attachment recognizes that the infant’s emotional tie to the caregiver is an evolved response that promotes its survival. Out of the baby’s experiences in the four phases of children construct an enduring affectionate tie that they can use as a secure base in the parents’ absence. The image serves as an internal working model or a set of expectations about the availability of attachment figures, their likleihoof of providing support during times of stress and the self’s interaction with those figures
A poor start in life can lead to poor health, nutrition, and inadequate learning, resulting in low adult earnings as well as social tensions. Negative consequences impact not only present but also future generations.
Nurturing care reduces the detrimental effects of disadvantage on brain structure and function which, in turn, improves children’s health, growth, and development
Family support and strengthening package - access to quality services (eg, antenatal care, immunisation, nutrition); skills building (eg, nurturing care and reduction of harsh discipline); and support (eg, social protection, safety networks, and family support policies).
Caring for the caregiver package - This two-generation package emphasises care and protection of parents’ physical and mental health and wellbeing, while enhancing caregivers’ capacity to provide nurturing care to their child
Early learning and protection package - This set of interventions integrates the support of young children with parental support and the facilitation of teachers’ and caregivers’ ability to create a nurturing environment in day care and early childhood centres. The emphasis is on quality and family support through parental empowerment, guidance on nutrition and care, and child protection
*that tend to be characteristic of many mental disorders.
Impairment in a development-based skill that is closely related to biological maturation
Comorbidity – specific disorders of language, learning and motor function
Having a diagnosis of one of the disorders subsumed under the ESSENCE framework markedly increases the probability of being afflicted with another neurodevelopmental diagnosis
Intellectual domains – reasoning, problem solving, planning, abstract thinking, judgment, academic learning and learning from experience
Adaptive functioning- failure to meet developmental and socio-cultural standards for personal independence and social resposibility
Deficits in the use of communication for social purposes, change communication to match contexts, rules of communication, understanding idioms, metaphors
A- deficits in socio-emotional reciprocity, non-verbal communicative behaviours and deficits in developing, maintaining and understanding relationships
B-stereotyped, repetitive motor movements, use of objects or speech. Insistence on sameness, inflexible adherence to routine, highly restricted and fixated interests and hypo or hyper responsivity. Level 1: requiring support, level 2: requiring substantial support and level 3: requiring very substantial support
The acquisition and the execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Manifested as clumsiness, slowness and inaccuracy of performance or motor skills (catching an object, riding a cycle, using scissors, cutlery). Stereotypic movt disorder – repetitive, seemingly driven and apparently purposeless motor behaviour. Specifiers- with or without self-injurious behaviour, associated with a known medical or genetic condition, and levels of severity- mild, moderate and severe. Tic disorders – sudden, rapid, recurrent, non-rhythmic motor movements or vocalisation – Tourette, persistent (chronic) motor or vocal tic disorder, providional tic disorder
Timing of eruption of teeth, ossification of bones, growth spurt associated with puberty. 87 language impaired children were prospectively followed up and assessed at ages 4, 4.5 and 5.5 years. 2/5ths showed normal language by 5.5 years and 15 years showed no difference in vocabulary and language comprehension skills. But performed less well on tasks of phonological processing and literary skills – suggesting that the catch up was not complete. For those who had language difficulties at age 5.5 years, fell further in their language functioning on follow up. Study done by Bishop and Edmundson 1987. What was the effect of stimulant medication, sex differences, lack of clinical measures in controls, attrition rate. The children in this study also came from socially advantaged backgrounds, had high IQ and no comorbidities
Stochastic - having a random probability distribution or pattern that may be analysed statistically but may not be predicted precisely. Epigenetic - epigenetics is the study of heritable phenotype changes that do not involve alterations in the DNA sequence. Basically relating to or arising from non-genetic influences on gene expression
During development, the DNA that makes up our genes accumulates chemical marks that determine how much or how little a gene is expressed. The collection of chemical marks is known as the epigenome. The different experiences children have rearrange those chemical marks
Family support and strengthening package - access to quality services (eg, antenatal care, immunisation, nutrition); skills building (eg, nurturing care and reduction of harsh discipline); and support (eg, social protection, safety networks, and family support policies).
Caring for the caregiver package - This two-generation package emphasises care and protection of parents’ physical and mental health and wellbeing, while enhancing caregivers’ capacity to provide nurturing care to their child
Early learning and protection package - This set of interventions integrates the support of young children with parental support and the facilitation of teachers’ and caregivers’ ability to create a nurturing environment in day care and early childhood centres. The emphasis is on quality and family support through parental empowerment, guidance on nutrition and care, and child protection.
Complex interplay between the child’s biological functioning, psychological adjustment, social context and development. Biological – degree of CNS involvement,. Psy- cognitive appraisal and coping style. Social- greater psychological adjustment of caregivers, use distraction. Developmental- depends on cognitive development