Developmental

Assessment

Dhaara Iyer (ST5)

October 2011

Learning objectives
What is development?
What is normal/abnormal?
How do you assess it?
Why do we want to know?

Child development
Process of acquiring new skills
Growth and increase in strength of

muscles
Improving muscle control
Change in cognition
Social relationships and personality

Influences on development
Parent-child
interaction

Individua
l factors

Cognitive processeslanguage, social

emotional and
perceptual motor

Parenting
behaviour

Functional competence
Social, Communicative, Cognitive,
Emotional

Environment
al influence

Psychological
processesattention, self
regulation ,social
cognition and
motivation

Child development domains

Gross motor
Speech, language

& hearing
Fine motor & vision
Social, emotional &
hearing

Gross motor
Rapid progress in

first 18 months
Head control by 6
weeks
Sit by 6 months
Stand by 10 months
Cruising 12months
Walks alone 15
months

Gross motor cont.

15months down stairs backwards
18months walks well, throws ball
24months up and down stairs 2 feet
per step ,kicks a ball

36months- rides tricycle

48 months hops on preferred foot
60months hops on each foot
72 months walks backwards on straight line

Fine motor & vision

Newborn-hands closed
6 weeks- fixes and follows to
90,hands to mouth
3months holds rattle
follows 180
4months palmar grasp
6 months- transfers
10 months pincer grip

Fine motor continued

12months pincer grasp and releases to

request, throws things to floor
18 months scribbles, may start showing
hand preference
24 months 6 cube tower, hand
preference, vertical line
36months copies circle, cuts with
scissors, threads large beads,9 cube
tower
48months copies +
60months copies square and triangle, can draw a
man
72months copies diamond

Speech, language & hearing

Newborn-startles to sounds
3 months - coos
6 months -babbles
10 months waves bye-bye
12 months 2-3 words
understands simple
instructions
15 months points on request
18 months - 10 words

Speech and language cont.

18 months 2 word sentences
24months short phrases
36 months knows name, sex,pronouns
talks incessantly
48months knows colours
60months knows opposites
72months knows comparatives

Social emotional &

behavioural
6 weeks smiles
10 months plays

peek-a-boo
12 months drinks
from a cup
18 months
symbolic play

Developmental milestones
Worry if
No responsive smile
No eye contact
Not reaching for
objects
Not sitting
Not walking
Not saying single
words
No 2/3 word

Age
8 weeks
3 months
5 months
9 months
18 months
18 months
30 months

Motor development-delay if
Fisting hands>3 months
Poor head control at 4 months
Persistence of primitive reflexes >6

months
Persistence of flexor hypertonia in LL
(popliteal angle >150 deg) >9 months
Not sitting independently-10 months
Not walking by 18 months.

Fine motor
Not reaching-6 months
Persistence of hand regard >9

months
No index finger exploration -12
months
Lack of purposeful exploration of
objects-12 months

Speech and language delay

No clear spontaneous words-18 months
Not showing understanding of common

objects/giving on request-18 months

Unable to follow simple requests-27 months
No word combinations-30 months
No 2-3 word sentences-3 yrs
No why,what questions/no sentences-4 yrs

Play and social development

No pointing/gesture-12 months
No joint attention-18 months
Absence of pretence play/ repetitive
play-24 months
Lack of social interest-3-4 yrs

Delayed development
Global delay
Specific impairments sensory,
motor, social, cognitive

Framework for
developmental examination
Systematic enquiry
Eliciting concerns
Current abilities
Identify
risk/protective
factors

Observations of
developmental
abilities

Assessment
Simple tools drawing, building

blocks
Standardised tools Denver
Multi professional assessments (CDC)

Limitations
Technique ask if not demonstrated
Range of normal very wide/variable
Reliability before 6 months less good

Development regression
Infection
Neurometabolic conditions
Syndromes

Exercise
4 groups
In each group two people take a turn
being a child.
Work together to try and assess the
age of the child assuming they have
normal development for their age.
Feedback to the whole group.

How old?
6-8 weeks
6 months
9months
12 months
18 months
2 years
3 years
4 years

Why assess?
Normal development - reassure
Pick up difficulties early
Intervention
Prevention
Cure
Support

Interventions
Physiotherapy
OT
Educational support
Behavioural support (Autism, ADHD)
Social and family support
Parenting skills
Medical eg thyroxine, hearing aid, steroids

Case 1
6y girl
Special school

Case 2
5y old boy
Weak
Unable to climb
stairs
Mild learning
disability

Case 3
4 y old boy
Doesnt speak
Poor eye contact
Doesnt participate in lessons

Case 4
Born at 24 weeks

gestation
Grade 4 IVH
Increased tone in legs
Global developmental
delay

Child Development Unit

Multi disciplinary

team
Assess needs
Inform Educational
process
Coordinate care
package

Any questions ?

Summary
Child development we have covered:

What is it?
How do we assess it?
Why do we want to know?

Thanks to Dr. Callaghan and Dr.Kim Neuling