Miracles and Challenges: Early Childhood Development

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Miracles and Challenges Early Childhood
Development
Birth To 5 Years
Kathleen C. Schlenz, MS, OTR/L, BCP
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Goals of this presentation

• 1. Outline major developmental milestones for
  children birth to five in 4 areas
• Gross Motor
• Fine Motor
• Cognitive
• Social / Emotional Skills.
• 2. Review red flags for developmental
  challenges
• 3. Discuss good parenting skills that support a
  child development.

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First 6 Months of Life Key Developmental Tasks

• To learn to trust and begin establishing secure
  attachments to people, especially mother.
• To learn how to get most important needs met.
• To establish eye coordination, gain control of
  large muscles and distinguish sounds.

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6 Months GrossMotor / Fine Motor

• Rolls over front to back and back to front
• Sits with support, then independently
• Reaches with one hand
• Transfers object from hand to hand
• Uses raking grasp

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6 Months Cognitive

• Finds partially hidden object
• Explores with hands and mouth
• Struggles to get objects that are out of reach
• Explores and experiments with objects by looking,
  swatting, mouthing
• Begins to imitate actions and movements

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6 Months Social/Emotional

• Enjoys social play
• Interested in mirror images
• Responds to expressions of emotion by others
• Smiles and laughs

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6 Months Good Parenting Skills

• Responsive, nurturing care is key to helping the
  child establish basic trust.
• State/arousal regulation is assisted by adequate
  parental responsiveness.
• Most parents benefit from good publications on
  development and the internet can be a source as
  well.
• Predictable parenting, including stimulation, is
  essential talking to the child (motherese
  mirroring), engaging in reciprocal play,
  providing opportunity for practice of emerging
  developmental skills.
• Safety is key attend to all recommendations.

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If by around age six months a child exhibits one
or some of these signs, a developmental delay may
or may not exist. These signs warrant further
assessment by a professional.
Warning Signs

• Indicators of possible developmental delays
• Does not respond to sound (startle or turn head
  in response to loud sound) or light (reflexive
  widening or blinking)
• Does not calm when held, spoken to, soothed
• Not rolling over or readying to sit (sitting when
  propped)
• Not making cooing noises or playing with sounds

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Warning Signs (continued)

• Indicators of possible developmental delays (six
  months)
• Does not recognize or prefer familiar individuals
  (caregivers) over strangers
• Not exploring hands, feet, objects, especially
  with mouth
• Not reaching for or swatting at hanging objects
• Not beginning to grasp objects placed in or near
  hand
• Feeding / weight gain difficulties
• Seems very tight in trunk, arms, or legs
  (straight or stiff) or has a rag doll-like
  appearance (floppy)

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1 Year-old Key Developmental Tasks

• To continue learning to trust parents and other
  caregivers.
• To feel secure in the world.
• To move the body independently.
• To learn ways other than crying to get
• adults to meet needs.
• To adjust to short periods away from caregiver.
• To develop eye/hand coordination.

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1 Year Gross Motor Skills

• Crawls forward on belly
• Assumes seated position unaided
• Gets up on all fours
• Creeps on hands and knees
• Transitions into several positions sitting,
  all-fours, prone (on stomach)
• Pulls self to stand
• Walks holding on to furniture (cruises)
• Stands momentarily without support
• May walk two or three steps without support

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1 Year Fine Motor Skills

• Bangs two cubes together
• Puts objects into container
• Takes objects out of container
• Lets objects go voluntarily
• Pokes with index finger
• Tries to imitate scribbling
• Uses pincer grasp

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1 Year Cognitive

• Experiments with objects in more complicated
  ways (shaking, banging, throwing, dropping)
• Finds hidden objects easily
• Looks for object or person when mentioned or
  named
• Imitates gestures (wave bye)
• Uses objects by function (puts cup to mouth,
  brushes hair, puts phone to ear)

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1 Year Social/Emotional

• Shy or anxious with strangers
• Cries when parent leaves
• Enjoys imitating people in play
• Shows preference for certain people and toys
• Tests parental responses to behavior
• Fearful of novelty, loud noises
• Prefers parent and/or regular caregiver over
  others
• Repeats sounds or gestures for attention
• Extends arm or leg to help when being dressed
• Finger-feeds self

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1 Year Good Parenting

• Attend to safety, especially in the early months
  of crawling, walking and climbing.
• Model language and provide loads of stimulation.
• Use affect (emotion) words to label the childs
  state/arousal.
• Use/teach distraction to cope with being upset.
• Provide clear behavioral limits with concise
  explanations.
• Promote good sleep habits.
• Establish good nutrition early now is a good
  time to introduce balance, moderation and pacing.
• Allow and encourage practice of new skills (e.g.,
  motor and language) and reward them.

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If by around age one year a child exhibits one or
some of these signs, a developmental delay may
or may not exist. These signs warrant further
assessment by a professional.
Warning Signs

• Indicators of possible developmental delays
• Not smiling, laughing
• Does not imitate sounds/words
• Not using jargon (baby talk tone of voice like
  adult speech but may have few real words)
• Not gesturing (e.g, pointing) with intent to
  communicate
• Not establishing eye gaze with loved ones

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Warning Signs (continued)

• Indicators of possible developmental delay (one
  year)
• Not responding to simple questions/commands (no!
  up?)
• Not sitting alone, creeping, readying to walk
  (walking may take place anywhere from 9-14
  months)
• Does not respond to name being called
• Seems detached or apathetic, very difficult to
  console
• Does not protest when trusted caregiver leaves
  and/or not bothered by presence of strangers
• Little interest in new toys, unfamiliar or
  unusual objects
• Not finger feeding or difficulty with table foods
• Despite praise, does not repeat actions that
  please caregivers e.g., clap hands

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Key Developmental Tasks for Toddlers

• To become a distinct person with a positive
  emerging self image.
• To explore an ever-widening world by improving
  the ability to talk, walk, use fine motor skills
  and coordination.
• To demonstrate increased memory for objects and
  events.
• To develop the beginnings of self control.

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Two Years Gross Motor Skills

• Walks smoothly, turning corners
• Begins to run
• Stands on tiptoes
• Kicks a ball
• Pulls toys while walking
• Carries large toy or several toys while walking
• Climbs onto and down from furniture unassisted
• Walks up and down stairs with support (hand rail)

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Two Years Fine Motor Skills

• Turns over containers to pour out contents
• Builds tower of four blocks or more
• Might use one hand more frequently than the other
  
• Scribbles spontaneously

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Two YearsCognitive

• Finds hidden objects
• Begins to sort by shape, color
• Begins multi-step make-believe play (cooking,
  feeding baby)
• Groups objects by function
• Varies imitation from model
• Begins to think before acting
• Completes simple inset puzzles

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Two Years Social/Emotional

• Imitates behavior, especially of adults and older
  children
• Increasingly aware of self as separate from
  others
• Enthused by company of other children
• Demonstrates increasing independence
• Begins to show defiant behavior (no!)
• Episodes of separation anxiety wax and wane,
  overall diminishing

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Two Years Good Parenting

• Play! Remember (learn) how to pretend and
  encourage it.
• Gentle, firm, predictable limits are essential,
  particularly around safety.
• Promote affective regulation by soothing, using
  language of affect. Model and teach appropriate
  behaviors.
• Expect testing of limits -- use if-then
  reasoning and apply this to your response.
• Establish/maintain household routines (bathing,
  bedtime, meals). Talk about them.
• Extend learning with books, stimulating toys,
  community encounters (park, library, walks,
  water/sand play).
• Expect irregularities of mood and appetite
  respond accordingly.

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If by around age two years a child exhibits one
or some of these signs, a developmental delay
may or may not exist. These signs warrant
further assessment by a professional.
Warning Signs

• Indicators of possible developmental delay
• Not putting 2-3 words together in meaningful,
  spontaneous sentences (not just repeating others)
• Not pointing to objects or persons named
• Frustrated when others cannot understand the
  childs attempts to communicate
• Not making eye contact with others seems
  uninterested in others
• Doesnt respond when name is called

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Warning Signs (continued)

• Indicators of possible developmental delay (age
  two)
• Not engaging socially, i.e., shifting gaze back
  and forth between an adult and a toy while
  talking about the top
• Not sorting objects or using them by function
• Seems withdrawn, uninterested, in his own world
• Difficulty manipulating objects such as large
  puzzle pieces, tower of blocks
• Not walking smoothly and rounding corners with
  ease
• Seems aggressive, difficult, often frustrated,
  angry, rageful, fearful
• Sleep disturbances or night terrors (should sleep
  through the night)

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Key Developmental Tasks in the preschool years

• Preschoolers
• Are learning, learning, learning
• to control bodily functions, feelings, and
  behavior...to speak more clearly... about
  safety...about where to go for comfort...and
  about how to play with others.
• Have established a sense of self as an individual
  with skills, likes and dislikes.
• Can separate thinking from feeling by making
  conscious choices, accepting limits and finding
  solutions to simple problems.
• Can usually distinguish fantasy from reality.
• Are comfortable with body parts and gender
  identity.

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Three Years Fine Motor Skills

• Makes vertical, horizontal, and circular strokes
  with pencil/crayon
• Turns book pages one at a time
• Builds a tower of more than six blocks
• Holds a pencil in writing position
• Screws and unscrews jar lids, nuts and bolts
• Turns rotating handles

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Three Years Cognitive

• Makes mechanical toys work
• Matches an object in his hand or room to a
  picture in a book
• Plays make-believe with dolls, animals, and
  people
• Sorts objects by shape and color
• Matches like objects
• Completes puzzles with three or four pieces
• Understands concept two

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Three Years Social/Emotional

• Imitates adults and playmates
• Spontaneously shows affection for familiar
  playmate
• Can take turns in games
• Understands concepts mine, yours and his/hers
• Expresses affection openly
• Expresses a wide range of emotions
• Separates easily from parents
• Objects to major changes in routine

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Three Years Good Parenting

• Step up expectations for behavior and
  accommodation to routine. Praise and value
  independence.
• Promote pro-social behavior by close monitoring
  of encounters with other children.
• Examine cultural-familial rules for affect,
  behavior. Understand your values and articulate
  them.
• Begin using consequential (if-then) discipline
  withhold privilege for misbehavior. Keep
  intervention brief concise.
• Extend learning by reading, watching TV together,
  puzzles, outdoor play, computer.
• Teach good coping skills by labeling frustration
  and encouraging perseverance.

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If by around age three years a child exhibits one
or some of these signs, a developmental delay
may or may not exist. These signs warrant
further assessment by a professional.
Warning Signs

• Indicators of possible developmental delay
• Not speaking in full, fairly elaborate sentences
• Not pronouncing consonant sounds (b, t, d, g) or
  blending sounds well (tr, cl) deleting parts of
  words
• Stranger cannot understand childs speech in
  context (the listener knows the topic)
• Does not understands and use pronouns (ours,
  yours, mine) articles (a, an, the), prepositions
  (over, under) readily

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Warning Signs

• Indicators of possible developmental delay (age
  three)
• Play does not include fantasy, roles, scripts
• Does not walk, climb, run, jump well
• Cannot pedal a bike or tricycle (with practice)
• Not matching/sorting by two attributes (size,
  color)
• Odd pencil/crayon grasp or cannot draw simple
  figures
• Not expressing or regulating emotion well (overly
  angry, sad, aggressive)
• Apathetic, disinterested, or destructive
• Overly preoccupied with certain topics, ideas, or
  age-inappropriate material

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Four Years Gross Motor Skills

• Hops and stands on one foot up to 5 seconds
• Goes up and down stairs without support
• Kicks ball forward and throws it overhand
• Catches bounced ball
• Moves forward and backward with agility

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Four Years Fine Motor Skills

• Copies squares and other shapes
• Draws a person with two to four body parts
• Uses scissors
• Begins to copy capital letters

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Four Years Cognitive

• Correctly names colors
• Counts and may know numbers
• Says first and last name
• Approaches problems from a single point of view
• Develops a clearer sense of time
• Follows three-part commands
• Recalls parts of a story
• Understands same/different
• Engages in fantasy play with roles and scripts

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Four Years Social/Emotional

• Interested in new experiences
• Cooperates with other children
• Role plays (mom, dad, teacher)
• Increasingly inventive in fantasy and role play
• Dresses and undresses
• Negotiates solutions to conflicts
• More independent
• Imagines that unfamiliar images are monsters
• Views self as a whole person involving body,
  mind, and feelings
• Difficulty distinguishing fantasy and reality at
  times

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Four Years Good Parenting

• Encourage the inquisitive mind of the
  three-year-old read, travel, visit museums, etc.
  
• Teach preschool skills in a fun, appealing way.
• Have explicit behavioral expectations (In our
  family, we talk about mad feelings) and enforce
  them reasonably. Set up clear responsibilities
  and consequences for meeting them.
• Keep behavioral expectations in line with
  development. Expect less when your child is
  upset, but push for more.
• Promote healthy sleep and eating habits.
• Teach empathy.
• Respond to fears with understanding, but dont
  encourage avoidant behavior.

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If by around age four years a child exhibits one
or some of these signs, a developmental delay
may or may not exist. These signs warrant
further assessment by a professional.
Warning Signs

• Indicators of possible developmental delay
• Does not say first and last name
• Speech is not understandable to strangers (should
  be mostly comprehensible even out of context)
• Not engaging in elaborate fantasy play with
  multiple characters and changing roles
• Not telling stories, either original or repeated
  (fairy tale, video tape)
• Not counting, learning alphabet, or identifying
  colors with exposure or instruction

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Warning Signs (continued)

• Indicators of possible developmental delay (age
  four)
• Not dressing self Not potty trained for day time
• Play does not include fantasy, roles, scripts
• Not matching/sorting by two attributes (size,
  color)
• Odd pencil/crayon grasp or cannot draw simple
  figures
• Not drawing basic shapes or form recognizable as
  a human figure
• Not expressing or regulating emotion well (overly
  angry, sad, aggressive)
• Apathetic, disinterested, or destructive
• Overly preoccupied with certain topics, ideas, or
  age-inappropriate material

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Warning Signs (continued)

• Indicators of possible developmental delays (age
  four)
• Does not walk, climb, run, jump well
• Cannot pedal a bike or tricycle (with practice)
• Movement is awkward, extremely clumsy, many
  falls cannot negotiate climbing toys
• Not yet kicking and throwing ball with practice
• Extremely upset by changes in routine
• Seems very fearful, angry, preoccupied
• Aggressive, rageful or vengeful
• Engages in repetitive or unusual behaviors
• Does not seek approval, affection, contact

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Five Years Gross Motor Skills

• Stands on one foot for ten seconds or longer
• Hops, somersaults
• Swings, climbs
• Learning to skip

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Five Years Fine Motor Skills

• Copies triangles and other geometric shapes
• Draws person with body
• Prints some letters, name
• Dresses and undresses self
• Uses fork, spoon, and (sometimes) a table knife
• Toilets independently

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Five Years Cognitive

• Counts ten or more objects
• Correctly names most colors
• Better understands time
• Sequences well (understands cause and effect)
• Knows about things used in the home/community
  (money, food, vehicles, appliances)
• May have rigid, all-or-nothing view of things

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Five Years Social/Emotional

• Wants to please friends
• Wants to be like peers
• More likely to agree to rules
• Likes to sing, dance, and act
• Shows more independence may visit a neighbor by
  self
• Aware of gender
• Able to distinguish reality from fantasy
• Sometimes demanding, sometimes eager

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Five Years Good Parenting

• Expect the five-year-old to test limits and
  explore provide guidelines for safety.
• Prepare for kindergarten.
• Involve the child in decisions that impact her
  allow choices appropriate to capacity.
• Help the child understand complicated emotions
  (guilt, embarrassment, ambivalence).
• Help the child understand his reaction to
  upsetting situations. Distinguish thoughts,
  feelings, behaviors.
• Parental coaching about emotion is correlated
  with childrens social competence by age 5.
  Girls are particularly vulnerable to guidance.

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If by around age five years a child exhibits one
or some of these signs, a developmental delay
may or may not exist. These signs warrant
further assessment by a professional.
Warning Signs

• Indicators of possible developmental delay
• Exposed to but not acquiring basic preschool
  skills (colors, counting, recognizing letters,
  writing letters)
• Not aware or able to maintain basic safety rules
  (danger of stove, traffic, etc.)
• Not making friends despite exposure to other
  children disliked or feared by peers
• Having difficulty expressing self (stuttering,
  hard to understand, cant find the right word)

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Warning Signs

• Indicators of possible developmental delay (age
  5)
• Not telling stories with clear beginning, middle,
  end
• Not using full sentences, asking/answering all wh
  questions (who, what, when, where, how, why)
• Does not give full name, address, town when asked
  (assumes an adult has attempted to teach this)
• Not competently feeding self with utensils
• Unable to toilet independently and without
  reminders, both day and night
• Not able to hop, somersault, stand on one foot,
  run, climb, and jump ably
• Extreme moodiness, anger, sadness
• Destructive, preoccupied or obsessed with certain
  ideas or actions

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Miracles and Challenges Supporting Early
Childhood Development
Thank you to Anne Farrell, PhD and the
Westchester Institute for Human Development, New
York for their contribution to this training.