Developmental Issues in Early Childhood and Elementary Age

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Developmental Issues in Early Childhood and
Elementary Age

• Kelly L. Lange, Ph.D.
• Clinical Neuropsychologist

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Goals for this talk

• Rationale for identifying possible problems
• Barriers in identifying problems
• Skill development possible problems
• Addressing concerns with parents
• Making appropriate referrals

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Why should we identify potential problems?

• Opportunity
• Expectations
• Potential for positive life-long impact
• Quality education of the whole child
• Struggling child affects the whole class

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Why we might not want to address concerns

• This isnt my area of expertise.
• How do I really know it could be a problem?
• This looks so mild that Im not really sure I
  should say something.
• I dont believe in labels.
• I dont know what to tell these parents or how
  to say it.

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Issues in Considering Development

• History Genetics Environment
• Some kids have a greater risk of problems
• Prematurity
• Genetic and metabolic disorders
• Medical problems with pregnancy delivery
• Adoption/IVF
• Drug abuse and domestic violence
• Historical info may not always be available

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Major Domains of Child Development

• Social/emotional skills
• Motor skills
• Language skills
• Other cognitive skills
• Visuospatial skills
• Attention executive functions
• Memory
• Academics

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Social/Emotional Functioning

• Seeking and maintaining eye contact
• Making and maintaining friendships with peers
• Joining activities and conversations
• Interpreting and expressing empathy
• Regulating negative emotions like frustration and
  anger
• Developing self-soothing skills
• Giving and receiving affection
• Recognizing and using personal boundaries for
  conversational topics and physical interaction

• Social reciprocity
• Creating relationships with adults other than
  parents
• Responding appropriately to novel situations,
  routines and people
• Identifying role changes when engaging with
  adults, peers, and older and younger children
• Learning basic social schemas
• Identifying ones own and others emotions and
  acknowledging that a range of emotions is
  normal
• Requesting help when needed

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Motor Functioning

• Gross motor
• Running
• Jumping
• Climbing
• Balancing

• Fine motor
• Cutting
• Drawing/writing
• Zipping
• Buttoning
• Snapping
• Scooping
• Pouring
• Tying shoes

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Language Skills

• Speech
• Articulation (making sounds accurately)
• Using appropriate pitch
• Using inflection and intonation
• Speaking at appropriate rate
• Controlling impulsive speech
• Using speech spontaneously
• Fluently naming colors, numbers,letters, etc.

• Language
• Recognizing grammatical constructs
• Interpreting/hearing verbal messages accurately
• Identifying sarcasm, joking, teasing
• Knowing and using conversational schemas
• Using appropriate person reference (talking
  about oneself in 1st vs. 3rd person)

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Other Cognitive Skills

• Visuospatial
• Recognizing patterns
• Identifying items on a background
• Sequencing
• Discriminating items
• Memory
• Repeating what was just heard/read/seen
• Retaining info over a delay (for an hour or a few
  months)
• Remembering both verbal and visual info

• Executive Functions
• Organizing
• Planning
• Imagining
• Thinking before doing
• Keeping multiple things in mind
• Multitasking
• Using contextual info
• Making associations between new and old info
• Reasoning/logical thinking

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Concerns in 3 4-year-olds

• Childs speech is difficulty to understand
• Persistent drooling
• Doesnt engage in fantasy play
• Doesnt use me and you appropriately
• Cannot copy circle
• Difficulty scribbling
• Excessive difficulty separating from parents

• Little response with people outside of family
• Little/no interest in interactive games
• Lashing out/raging when angry or upset
• Cannot grasp crayon with thumb and fingers
• Ignores other children
• Doesnt use sentences with gt3 words

http//aap.org/healthtopics/stages.cfmearly
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Concerns in 4 5-year-olds

• Extremely fearful or timid
• Extremely aggressive
• Difficulty concentrating for gt 5 min
• Little interest in playing with other kids
• Refuses to respond to other people or does so
  superficially
• Rarely uses fantasy or imitation in play
• Seems unhappy or sad much of the time

• Limited interests or activity choices
• Avoids or seems aloof with children and adults
• Limited emotional expression
• Difficulty dressing or toileting
• Cannot wash hands or brush teeth efficiently
• Cannot understand two-part commands
• Seems very passive

http//aap.org/healthtopics/stages.cfmearly
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Concerns in children 6

• Difficulty sustaining, dividing, shifting
  attention
• Difficulty completing homework efficiently
• Excessive disorganization
• Persistent sadness, anxiety, school refusal
• Disruptive behavior during classroom work
• Frequently misunderstanding verbal messages
• Difficulty making and maintaining friendships
• Unusual errors in reading and arithmetic
• Difficulty learning letter-sound associations

http//www.ldonline.org/ldbasics/signs
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Approaching Parents with Concerns

• Let parents know that you look for developmental
  issues
• Be authoritative yet supportive
• Give constant feedback from the start of school
• Establish a connection with parents early on
• Collect evidence
• Anecdotes
• Observations
• Written/drawn work
• Check out your suspicions with colleague Am I
  on the right track?
• Mention your growing concern I think we should
  talk more
• Suggest a course of action
• Wait and see
• Try this at home (and make recommendations)
• Make a referral

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Making Referrals

• What are the concerns?
• Are there medical issues?
• How old is the child?
• Does the family have adequate financial
  resources?
• Is there suspicion that the family is withholding
  information?

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Comparing Allied Health Professionals
Job Title Degree Training Areas Availability
Speech-Language Pathologist MA or MS Development, cognition, therapy, neurobiology Widely
Occupational Therapist BA/BS or MA/MS Development, therapy, physiology Widely
Physical Therapist MA or MS Development, therapy, physiology, biology Widely
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What Allied Health Professionals Look At
Speech-Language Pathology Occupational Therapy Physical Therapy
Speech Language Voice Swallowing Social skills Executive functions Development Medical history (some) Adaptive skills (grooming, dressing, eating) Gross fine motor skills Daily life skills Development Muscle tone Coordination Functional skills Rehabilitation Development Medical history
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Comparing Advanced Professionals
Job Title Degree Training Areas Availability
Pediatrician MD Medicine, neurobiology, development, pharmacology Widely
Clinical Psychologist PhD Development, mental health, quantitative assessment, therapy Widely
Neuropsychologist PhD Development, mental health, quantitative assessment, therapy, neurobiology, cognition Limited
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What Advanced Professionals Look At
Pediatrician Clinical Psychologist Neuropsychologist
Medical status Basic developmental milestones Motor functioning Hearing Vision Psychological status Academic problems Social/emotional functioning Family/parenting issues Development Adaptive/daily life skills Medical, school, social histories Items to the left plus Motor functioning Language Visuospatial skills Memory Executive functions Attention Academic status
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When Families Choose Public Services
For Ages 0-5
For Ages 5

• Regional Center
• Specific referral process - may require
  pediatricians involvement
• Diagnoses, evaluations, therapeutic
  interventions are available
• Typical program provides free services

• Local Public School District
• Family calls the Special Education Department to
  request an evaluation
• Children may qualify for existing services
• Families do NOT need to attend public schools to
  use this service

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Comparing Educational Referrals
Job Title Degree Training Areas Availability
School Psychologist MA or MS Development, quantitative assessment, therapy, education Very limited, typically only in public schools
Educational Therapist MA or MS Development, quantitative assessment, education, specialized programs Widely
Behavior Analyst MA or MS Psychology and/or education, quantitative assessment, development Very limited, typically only in public schools
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Monitoring Progress

• Wherever families choose to get help
• ask for updates
• be involved, if you can
• give parents feedback about progress
• be honest about any conflicts that arise

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Development Books That I Like

• Einstein Never Used Flash Cards
• By Kathy Hirsh-Pasek Roberta Michnick Golinkoff
• Your Childs Growing Mind
• By Jane Healy