CMED 212 Developmental Screening & Theories of Development PDF

Conception to Adulthood 001 CMED Developmental Scr...

Conception to Adulthood 001 CMED Developmental Screening & Theories of Development 212 Dr. Maureen B. Teves, M.D. Date 09/03/2024 T: Aclon, Agacita | E: Sabio, Villanueva Must-know Lecturer Book Previous trans ⚠ 🗨 📖 📄 C. Ecobiodevelopmental Framework I. DEVELOPMENTAL MODELS Broader model A. Medical Model o 📖 With the advances in neurology, genomics Signs and symptoms are the focus. (including epigenetics), molecular biology, and the o 📖 Presumes that a patient presents with signs and social sciences, a broader model, the symptoms and a physician focuses on diagnosing and ecobiodevelopmental framework, has emerged. treating diseases of the body. Social + Physical + Biologic Process Social and psychological aspects are neglected. o 📖This framework emphasizes how the ecology of o 📖 This model neglects the social and psychologic childhood (social and physical environments) interacts aspect of a person who exists in the larger realm of the with biologic processes to determine outcomes and life family and society. trajectories. Early influences, particularly those producing toxic levels of stress, affect the individual B. Biopsychosocial Model through their impact on the body’s stress response Society and community systems are simultaneously systems, brain development, and modification of gene considered expression. o 📖 Societal and community systems are Epigenetics simultaneously considered along with more proximal o 📖 Epigenetic changes, such as DNA methylation and systems that make up the person and the person’s histone acetylation, may be influenced by early life environment (Fig. 1). A patient’s symptoms are experiences (the environment) and impact gene examined and explained in the context of the patient’s expression without changing the DNA sequence. existence. These changes can produce long-lasting effects on the Multidimensional health and well-being of the individual and may be o 📖 This multidimensional model can be used to passed on to future generations (Fig. 2). understand health and both acute and chronic disease, and this model has been increasingly used to develop care models over the past few decades. Figure 2. Ecobiodevelopmental framework for early childhood policies and programs. (Adapted from Center on the Developing Child. The foundations of lifelong health are built in early childhood. 2010; Available at: http://www.developingchild.harvard.edu.) Figure 1. Continuum and hierarchy of natural systems in the biopsychosocial model. 🗨 This figure shows how the biopsychosocial model enables us to examine the patient as a whole. Page 1 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 reorganization of neuronal circuits also play important roles in brain plasticity. Increase or decrease in synaptic activity result in persistent increases or decreases in synaptic strength. 📖 Thus experience (environment) has a direct effect on the physical and therefore functional properties of the brain. Children with different talents and temperaments (already a combination of genetics and environment) further elicit different stimuli from their varying environments. 📖 Periods of rapid development generally correlate with periods of great changes in synaptic numbers in relevant areas of the brain. Accordingly, sensory deprivation during the time when synaptic changes should be occurring has profound effects. The effects of strabismus leading to amblyopia occur quickly during early childhood; patching the eye with good vision to reverse amblyopia is less effective in late childhood. Early experience is particularly important because learning proceeds more efficiently along established synaptic pathways. However, some plasticity of the brain continues into adolescence, with further development of the prefrontal cortex, which is important in decision-making, future planning, and emotional control; neurogenesis persists in adulthood in certain areas of the brain. 📖 Early traumatic experiences modify the expression of stress mediators (the hypothalamic-pituitary-adrenal axis) and neurotransmitters, leading to changes in brain connectivity and function. These effects may be persistent, leading to alterations and dysfunction in the stress response throughout life. Chronic stress has negative effects on cognitive functions, including memory and emotional regulation. Positive and negative experiences do not determine the ultimate outcome but shift the probabilities by influencing the child’s ability to respond adaptively to future stimuli. 📖 There is increasing evidence that positive experiences and relationships can buffer the impact of negative or traumatic experience and toxic stress. In fact, there is a recent call for pediatrics to recognize and promote relational health as a protective factor. By promoting positive relationships, labeled safe, stable, and nurturing relationships (SSNRs) within primary care, healthcare providers can work with families to build relational health, thereby combatting the deleterious effects of toxic stress and promoting resilience. Pediatric care can do this by employing a public health approach, partnering with families and communities, to build healthy relationships by connecting to and integrating with primary, secondary, and tertiary prevention programs. This can include embedding interventions within primary care and creating robust referral Figure 3. Infographic on Epigenetics networks to connect families to needed services. Neuronal plasticity o 📖 Critical to learning (and therefore development) is D. Biologic Influences neuronal plasticity, which permits the central nervous 📖 Biologic influences on development include genetics, system to reorganize neuronal networks in response to in utero exposure to teratogens, the long-term negative environmental stimulation, both positive and negative effects of low birthweight (neonatal morbidities plus (🗨 simply put, learning). An overproduction of increased rates of subsequent adult-onset obesity, coronary neuronal precursors eventually leads to about 100 heart disease, stroke, hypertension, and type 2 diabetes), billion neurons in the adult brain. Each neuron postnatal illnesses, exposure to hazardous substances, develops on average 15,000 synapses by 3 years of and maturation. Adoption and twin studies consistently show age. that heredity accounts for approximately 40% of the variance Pruning in IQ and in other personality traits, such as sociability and o 📖 During early childhood, synapses in frequently desire for novelty, whereas shared environment accounts for used pathways are preserved, whereas less used another 50%. The negative effects on development of prenatal one’s atrophy, a process termed pruning. Changes in exposure to teratogens, such as mercury and alcohol, and of the strength and number of synapses and postnatal insults, such as meningitis and traumatic brain injury, have been extensively studied. Any chronic illness can affect growth and development, either directly or through changes in Page 2 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 factors such as nutrition, parenting, school attendance, peer orphanages, devoid of opportunities for attachment, have interactions, or self-esteem. severe developmental deficits. Two influences identified: a) Temperament a) Attachment 📖 Temperament describes the stable, early appearing 📖 Attachment refers to a biologically determined tendency of individual variations in behavioral dimensions, including a young child to seek proximity to the parent during times of emotionality (crying, laughing, sulking), activity level, attention, stress and to the relationship that allows securely attached sociability, and persistence. The classic theory proposes nine children to use their parents to reestablish a sense of well- dimensions of temperament (Table 1). These characteristics being after a stressful experience. Insecure attachment may lead to three common constellations: (1) the easy, highly be predictive of later behavioral and learning problems. adaptable child, who has regular biologic cycles; (2) the 📖 At all stages of development, children progress optimally difficult child, who is inflexible, moody, and easily frustrated; when they have adult caregivers who pay attention to their and (3) the slow to-warm-up child, who needs extra time to verbal and nonverbal cues and respond accordingly. In early adapt to new circumstances. Various combinations of these infancy, such contingent responsiveness to signs of clusters also occur. overarousal or under arousal helps maintain infants in a state of quiet alertness and fosters autonomic self-regulation. b) Consistent Contingent Responses 📖 Consistent contingent responses (reinforcement depending on the behavior of the other) to nonverbal gestures create the groundwork for the shared attention and reciprocity that are critical for later language and social development. 🗨 A child’s nonverbal expression could be manifested in crying. The one who will be constantly attended to will have secure attachment. F. Social And Eccologic Factors 📖 Contemporary models of child development recognize the Figure 4. Temperamental Characteristics: Descriptions and critical importance of influences outside the mother–child Examples dyad. Fathers play critical roles, both in their direct 📖 Temperament has long been described as biologic or relationships with their children and in supporting mothers. As “inherited.” Monozygotic twins are rated by their parents as traditional nuclear families become less dominant, the temperamentally similar more often than are dizygotic twins. influence of other family members and caregivers Estimates of heritability suggest that genetic differences (grandparents, foster and adoptive parents, same-sex account for 20–60% of the variability of temperament within a partners) becomes increasingly important. Furthermore, the population. The remainder of the variance is attributed to the presence of nurturing and stable caregivers, in or out of the child’s environment. Maternal prenatal stress and anxiety is nuclear family, can help to buffer the impact of a parent who associated with child temperament, possibly through stress may struggle with mental illness, substance use, or other hormones. However, certain polymorphisms of specific genes afflictions. As children grow within their larger ecosystem, it is moderate the influence of maternal stress on infant important to recognize and include all relevant caregivers in temperament. Children who are easily frustrated, fearful, or the child’s care. irritable may elicit negative parental reactions, making these 📖Families function as systems, with internal and external children even more susceptible to negative parenting boundaries, subsystems, roles, and rules for interaction. In behaviors and to poor adjustment to adversity. Longitudinal families with rigidly defined parental subsystems, children may twin studies of adult personality indicate that changes in be denied any decision-making, exacerbating rebelliousness. personality over time largely result from dissimilar In families with poorly defined parent–child boundaries, environmental influences, whereas stability of temperament children may be required to take on responsibilities beyond appears to result from genetic factors. their years or may be recruited to play a spousal role. 📖 The concept of temperament can help parents understand 📖Family systems theory recognizes that individuals within and accept the characteristics of their children without feeling systems adopt implicit roles. Although birth order does not responsible for having caused them. Children who have have long-term effects on personality development, within difficulty adjusting to change. may have behavior problems families the members take on different roles. One child may when a new baby arrives or at the time of school entry. In be the troublemaker, whereas another is the negotiator, and addition, pointing out the child’s temperament may allow for another is quiet. Changes in one person’s behavior affects adjustment in parenting styles. Behavioral and emotional every other member of the system; roles shift until a new problems may develop when the temperamental equilibrium is found. The birth of a new child, attainment of characteristics of children and parents are in conflict. If parents developmental milestones such as independent walking, the who keep an irregular schedule have a child who is not readily onset of nighttime fears, diagnosis of a chronic illness, or death adaptable, behavioral difficulties are more likely than if the of a family member are all changes that require renegotiation child has parents who have predictable routines. of roles within the family and have the potential for healthy adaptation or dysfunction. E. Psychological Influences 📖Bronfenbrenner’s ecologic model depicts these The influence of the child-rearing environment dominates most relationships as concentric circles, with the parent–child dyad current models of development. Infants in hospitals and at the center (with associated risks and protective factors) and Page 3 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 the larger society at the periphery. Understanding the child’s greater ecosystem is important to understand their family and the context of their growth. Factors such as poverty, systemic racism, access to education, transportation, food, housing, parental employment, and local support systems are influential factors in a child’s well-being. Whenever possible, identifying community supports and assets for families can help promote health and development. II. GROWTH AND DEVELOPMENT Growth – an increase in size with structural and physiologic changes Development – progressive series of changes that occur in an Figure 7. Psychosexual Stages of Development orderly, predictable pattern as a result of maturation and experience Why is it important for pediatricians to differentiate normal from abnormal development? o To effectively monitor the child’s progress. o To identify delays or abnormalities in development. o To help identify and obtain needed services. o To counsel the parents and caretakers. Figure 8. Psychosexual Theory a) Oral Stage (0 to 1 year) Erogenous zone: mouth The energy or driving force is fixated on the baby’s mouth, that’s why we call it the oral stage. The primary source of interaction occurs in the mouth. This is resolved by sucking, biting, and that is what an infant usually does. And that is how issues/conflicts are shown and resolved (when the baby is fed or given a certain comfort and Figure 5. Prevalence of Developmental-Behavioral Disorders trust given by the parent). and Other Chronic Medical Conditions in Children The conflict will arise when the baby is weening and dependent on the caregiver. 🗨In private practice, we do not always deal with these developmental disorders because they are usually often 📖 During the oral stage, Freud argues that oral activities such referred to developmental pediatricians especially if there’s as sucking, and biting gives a child gratification as well as concern raised by the parents. nourishment. Conflict centers on the nature and extent of oral gratification. III. CLASSIC STAGE THEORIES o Early weaning (cessation of breastfeeding) can lead to frustration. Excessive gratification can lead an infant to expect that it will routinely get anything they want. Oral traits include dependency, gullibility, and excessive optimism/pessimism (depends on the child experience on gratification). He theorized that adults with oral fixation would experience exaggerated desires for oral activities, such as smoking, Figure 6. Classic Stage Theories overeating, alcohol abuse, and nail biting, and may desire clinging, dependent relationships. A. Psychoanalytic Theory: Psychosexual Sigmund Freud b) Anal Stage (1 to 3 years) Theory is built upon 5 stages. Erogenous zone: Bowel and Bladder control 📖 The core Freudian theory is the idea of body-centered (or The difficulty will arise during the toilet training. broadly, “sexual”) drives; the emotional health of both the child 📖 Gratification is attained through contraction and relaxation and the adult depends on adequate resolution of these of the muscles that control elimination of waste products, that conflicts. is reflexive during the first year, will now be voluntary. 📖Freud believed that children encounter conflict during each stage of psychosexual development, and any insufficient or excessive gratification could lead to fixation. Page 4 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 The general issue of self-control may bring conflict between While his theory was impacted by psychoanalyst Sigmund parents and child. Anal fixations may stem from this conflict Freud’s work, Erikson’s theory centered on psychosocial and leads to: development rather than psychosexual development. o Anal-retentive traits such as excessive use of self- His theory described the impact of social experience across control: perfectionism. the whole lifespan. o Anal-expulsive traits such as “let it all hang out” Erikson was interested in how social interaction and character: carelessness, messiness, and sadism. relationships played a role in the development and growth of human beings. c) Phallic/Oedipal Stage (3 to 6 years) 📖 Erikson’s work calls attention to the intrapersonal Erogenous zone: genitals challenges facing children at different ages in a way that The child is being curious of the genital areas, at this stage the facilitates professional intervention. child will start to see the difference between genders. Oedipus complex, the boys will be closer to their moms and a) Stage 1: Trust Vs. Mistrust view their dads as rivals. This can be resolved by introducing similarities between the child and his father to bond with. 📖During this stage the child may develop strong attachments to the parent of other gender and begin to view the parent of same gender as rival for affection. These complexes are usually resolved about the age of five or six. o Oedipus complex in boys o Electra complex in girls d) Latent Stages (6 to Puberty) Libido inactive The period of exploration, sexual energy in this stage is latent because they are not focus on sexual energy but more on intellectual, capabilities, development of new skills, and Figure 10. Trust vs Mistrust (0-18 months) forming relationships with others. Most fundamental stage in life. 🗨 According to Freud, this stage does not usually develop into Child is utterly dependent on adult caregivers. fixation. 📄 Infancy psychosocial development 📖Freud believed that the pressures of the two complexes o Psychosocial conflict: trust vs mistrust. cause them to repress all sexual urges. In doing so they enter ▪ “Can I trust the people around me?” the period of latency, during which their sexual feelings remain o Basic Virtue: Hope unconscious, they prefer playmates of their own gender and ▪ “Important event: Feeding” focus on schoolwork. 📄 Caregivers or Mother of the child is the key to development on this stage. e) Genital Stage (Puberty to Death) o If a child successfully develops trust, it will feel safe and Maturing sexual interests secured growing up. 🗨 The stage where one develops sense of self, and strong o Caregivers who are inconsistent and emotionally sexual interest to others. unavailable, will cause the child to develop mistrust in 📖 Adolescences are attracted to resemblance of their the future. It can result to a child who is fearful and parents. might grow up to believe that the world is inconsistent o Girls are attracted to boys who resemblance their dads and unpredictable. o Boys are attracted to girls who resemblance their 📄 According to Erickson, this trust and mistrust has an effect moms. over the child’s communication and relationship to other When all the stages are completed, the person should be people for the remainder of their life. sexually matured and completely healthy. 📖 Infants depends on their primary care givers and expect that the environment meets our needs. B. Psychoanalytic Theory: Psychosocial b) Stage 2: Autonomy Vs. Shame and Doubt Figure 9. Psychosocial stages of development Erik Erikson was an ego psychologist who developed one of the most popular and influential theories of development. Figure 11. Autonomy vs Shame & Doubt (18 mos-3 yrs) Page 5 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 Focused on children developing a greater sense of personal d) Stage 4: Industry Vs Inferiority control. 📄 Important tasks in psychosocial Stage 2 📄 The major question in this is ‘Is it okay if I do this?’ ‘What should I do, should I ask for others help?’ The role of caregivers is to encourage the child to do things on their own. Let them control over things. 📄 It is important for them to gain control over themselves, for them to gain confidence in their ability to do things. 📄 According to Erickson, the child who successfully gained control over themselves is secured and confident. While those who didn’t, will feel a sense of self-doubt and inadequacy. 📖 During this period, the child’s relationship with parents and friends can encourage development of self-direction and initiative, or feelings of shame ang guilt. Children at this stage Figure 13. Industry Vs. Inferiority (6-11 years old) should develop feelings of self-control over physical functions and a sense of independence. Children become capable of performing more complex tasks. As a result, they start to master new skills. c) Stage 3: Initiative And Guilt Children who are commended end encouraged by parents/teachers develop the feeling of competence and belief in their abilities Those who receive little/no encouragement from their parents/teachers/peers will doubt their abilities. 📄 School-age psychosocial development o Psychosocial Conflict: Industry vs inferiority ▪ “How can I be good or bad?” o Basic virtue: Competence ▪ “Important event: School” 📄During this stage, the child become capable of performing more complex tasks. As a result, they are motivated to master new skills. Those children who are encourage and commended by parents or teachers, will feel competence and believe on their abilities. And those who receive little encouragement from their parents will become doubtful on their abilities and self. Figure 12. Initiative vs Guilt (3-5 yrs) 📄During this stage, it is very important to have a very supportive circle for the child. As it focuses on the Stage 3: Initiative vs Guilt development of the child’s self-esteem and confidence. And Children begin to assert their power and control over the world this also plays a big part on the child’s personality as it grows through directing play and other social interactions. older. 📄 Preschool psychosocial development 📄During which a child is dealing with academic and social o Psychosocial Conflict: Initiative vs Guilt challenges in school. ▪ “Am I good or bad?” o A positive outcome contributes to a sense of industry o Basic Virtue: Purpose o Setbacks leads to feelings of inferiority. ▪ “Important event: Exploration, play” 📄 Let the child play and explore so they will be able to explore e) Stage 5: Identity Vs Confusion their sense of purpose. 📄 At this point, the child will now view the world as something trustworthy. So, they will now take initiative to try new things. A child with initiative and guidance from parents will have a sense of resilience that as they failed to do what they want; they won’t feel bad about it and know that it is okay to fail and would just try again. While the one who didn’t have will feel bad about themselves when they fail. 📄 And it is the role of the primary caregivers to peak their interests on trying out what they want to do. Success on this stage will lead to a sense of purpose, and failure to overcome will lead to feeling of guilt. 📖The child begins to assert control over the environment and strive to master adult skills. Figure 14. Identity Vs. Confusion (12-18 years old) Page 6 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 Adolescence stage 📄 Middle adulthood psychosocial development Adolescents explore and develop their independence and o Psychosocial Conflict: Generativity vs Stagnation sense of self. ▪ “How can I contribute to the world?” They begin to question who am I really? o Basic virtue: Care The conflict is set in developing personal identity ▪ “Important Event: Parenthood and work” Success leads to strong sense of self and remain throughout 📄 Important events are having work, good career and being life a parent. Resolving the crisis of development involves committing to a 📄 Generativity is making a mark on the world by caring for particular identity (career path, social groups to associate with, others and creating or accomplishing things that would make etc.) the world a better place to live in. On the other hand, 📄Adolescent psychosocial development Stagnation refers to the failure to contribute. As this individual, o Psychosocial Conflict: Identity vs Confusion may feel disconnected or uninvolved to their community. ▪ “Who am I?” o Basic virtue: Fidelity h) Stage 8: Integrity Vs Despair ▪ “Important event: Social Relationship” This is where they would want to develop their own self-identity and for them to be able to successfully find themselves, they need to have a strong sense of self that will remain throughout life. As a primary caregiver, we could help them by giving them room or space to develop their own identity with enough encouragement and guidance. f) Stage 6: Intimacy Vs. Isolation Figure 17. Integrity Vs. Despair (65 onwards) 📄 Psychosocial development in maturity o Psychosocial Conflict: Integrity vs. despair ▪ “Did I live a meaningful life?” ▪ “Was my life enough?” o Basic Virtue: Wisdom ▪ “Important Event: Reflecting back on life” 📄Respect patters 📄Begins to discuss the problems of his/her morality 📄Onset of this stage is triggered by life events such as Figure 15. Intimacy Vs. Isolation (19-40 years old) retirement, loss of spouse, friends, and facing terminal illness. 📄 Psychosocial development in young adulthood o Psychosocial Conflict: Intimacy vs Isolation IV. COGNITIVE THEORY ▪ “Will I be loved, or will I be alone?” o Basic virtue: Love ▪ “Important event: Romantic Relationship” 📄 An important event is having romantic relationship. 📄 Major conflict centers on forming intimate and loving relationships with other people. 📄 This is where we are now. Success on this stage will give a sense of fulfilling love and failure would give a feeling of loneliness and isolation. g) Stage 7: Generativity Vs. Stagnation Figure 18. Cognitive Theory A. Sensorimotor Stage (0-2 y/o) Figure 16. Generativity Vs. Stagnation (41-65 years Old) Figure19. Sensorimotor stage Page 7 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 🗨 During initial phase of development, the child uses the skills 🗨 This period corresponds to middle childhood. and abilities that they were born with such as sucking, 🗨 Characterized by the development of logical thinking. grasping, looking, listening to learn more about the 🗨 In the picture above, the child associates sneezing with the environment. fur of the cat. 🗨 They experience and gain knowledge through their sense 🗨 Thinking becomes concrete and children become much and motor movements. more logical and sophisticated in their thinking. 🗨 Through trial and error, children discover more about the 🗨 You can train the child of putting themselves in other shoes world around them. 🗨 It is through the sense and motor skills that the infant will D. Formal Operational gain a basic understanding of the 🗨 Senses that a child is born with, combined with physical activities are continuously being developed. This will allow them to interact and be aware of what is around him. 🗨 When a child starts to place things in their mouth or get things from the table and start throwing them, it is not advisable to get the thing and give it to them and for them to throw it back down. It’s a way for them to learn that it falls. B. Preoperational Stage (2-7 y/o) Figure 22. Formal operational 🗨 Thinking becomes much more sophisticated and advanced. 🗨 They think about abstract and theoretical concepts. 🗨 Skills such as logical thoughts, deductive reasoning, and systematic planning emerge in this stage. 🗨 Final stage in cognitive theory of development Figure 20. Preoperational stage V. MORAL THEORY 🗨 Begins around 2 or 3 years old as they start to talk, and this will last until approximately 6 or 7 years old 🗨 Children begin to engage in symbolic play and manipulate symbols. They have magical thinking. However, they do not understand concrete logic. 🗨 They cannot manipulate information. For them, what you see is what you get. 🗨 They perceived the world through their point of view, termed as egocentrism. 🗨 This stage corresponds to pre-school period. 🗨 Thinking is dominated by perception not Figure 23. Moral Theory abstraction. 🗨 This theory focuses on moral reasoning (difference 🗨 Animism, belief of supernatural and power of wishes. between right and wrong) 🗨 After 2 years, a child may develop a concept of 🗨 Development of moral reasoning happens in six stages. himself/herself as an individual and senses the need of Individuals progress in the stages on hierarchical order as their people. cognitive abilities develop. C. Concrete Operational (7-11 Y/O) Figure 21. Concrete Operational stage Figure 24. Stages of Moral Development. Page 8 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 🗨 Stages are structured in three levels (preconventional, VII. DEVELOPMENTAL DOMAINS AND THEORIES OF conventional, and post-conventional) EMOTION AND COGNITION A. Stage 1: Obedience and Punishment 🗨 Moral judgment is based on moral judgment. 🗨 Around 2-3 years old B. Stage 2: Individualism and Exchange 🗨 Motivated by self-interest. 🗨 Child recognized that it’s not just one view that handed down by the authority, that different individual has different view of point. C. Stage 3: Good Interpersonal Relationships 🗨 A child does good in order to be seen as good by others. 🗨 Looks for social approval D. Stage 4: Maintaining social order Figure 26. Developmental domains and theories of emotion and cognition 🗨 Becomes aware of the wider rules of society. A child’s development can be tract using these different 🗨 Judgments are made to uphold the law and avoid guilt. domains such as: o Gross motor E. Stage 5: Social Contract and Individual rights o Fine motor 🗨 Becomes aware that laws and rules exist for the good of the o Social greatest number. o Emotional 🗨 Rules will make sense only if they will serve a specific or o Language right purpose. o Cognitive Each of these categories there are developmental changes F. Stage 6: Universal Principle Stage that will lead into attainments that we want to see. 🗨 Guided by universal ethical principles. 🗨 Developed set of moral guidelines which may or may not fit A. STREAMS of Development the law. These streams of development by Dr. Arnold Capute. According to him, the process of development should be fluid 🗨 Not everyone can reach this stage. or dynamic. 🗨 According to Kohlberg, a few people are able to reached Each of these developments has milestones ascribe specific this stage. stages of expected achievements. o Gross motor VI. PRINCIPLES ON DEVELOPMENT o Visual-motor problem–solving o Speech and language o Social o Adaptive skills Development is an orderly, timed, and sequential process that occurs with such regularity that is predictable. - Dr. Arnold Gessel Timed - because we want to see the achievement of this specific milestones occurs at the age where a child should achieve it. B. Developmental Milestones Do not represent the process of development, rather, they reflect the product of a developmental process. Figure 25. Principle of Development Prescence of these milestones are the measure by which normal or abnormal development is assessed. G. Lifelong Change is apparent across the life span, an early experience C. Abnormal Development will the later development. Occurs when the timing, order, or sequence of the acquisition of milestones within a given stream or across several streams H. Multidirectional is disturbed. There are gains in some areas of development while showing loss in some areas also. I. Multidimensional There is change across different areas of domains and all domains influence each other. Page 9 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 Figure 27. Assessment of abnormal development Normal Developmental Delay o 🗨 Milestone within one or many streams, they are attained but in a very delay sequence. For example, speech delay, or motor delay or both. o 🗨 In this case, you would see in the graph that the second stream did not grow along with the others, so this could be delay. Developmental Deviance o 🗨 There is an uncustomary milestone attainment with single stream development. o 🗨 Mostly seen on children with autism spectrum disorder (ASD Figure 28. Red Flags in Developmental Screening and o 🗨 For example, a child who is reciting the alphabet Surveillance before he could be able to speak, a child who could identify all the flags of the world, but he is only 2 years old, a child who able to identify colors but cannot be able to say “mama” “papa.” These are red flags that needed an assessment for the development of the child. Developmental Dissociation o 🗨 A descriptive term which indicates attainment developmental skills at significantly different traits between two or more domain of development. o 🗨 For example, there is a delay motor development. In a child with cerebral palsy, he can attain language and cognitive skills at certain age but cannot be able to sit and is able to do other motor skills. Developmental Regression o 🗨 It is called the autistic regression. Figure 29. This table is from PPS that shows an eye view of o 🗨 The loss of previously acquired developmental how to see or observe a child to grow milestone or skills or the failure to acquire new ones. o 🗨 For example, a child who could be able to speak IX. DEVELOPMENTAL AND SURVEILLANCE “mama” “papa” at 2 years old but forgets when he was SCREENING 3 years old. 🗨 According to CDC data of 2022 Prevalence of o 🗨 Very common in autism developmental disabilities From 7.4% in 2019 to 8.56% in 2021 VIII. RED FLAGS IN DEVELOPMENTAL SCREENING ASD: 1 in 36 (as of 2024) AND SURVEILLANCE Cerebral Palsy: 1 to 4 per 1000 live births 🗨 These indicators suggest that development is seriously ADHD: 11.3% or 1 in 10 disordered, and that the child should be promptly referred to a developmental or community pediatrician. A. Developmental Surveillance Red flags 🗨 This is why developmental surveillance is important, that o Developmental markers suggesting the need for further should be done at every well child visit and should have the neurodevelopment evaluation. following component o Eliciting and attending to the parent's concern about their child's development o Maintaining a developmental history o Making accurate and informed observations of the child o Identifying the presence of risk and protective factors o Documenting the process and findings Page 10 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 🗨 During the consultation that you are able to tell whether a X. EXAMPLES OF TABLES THAT EMPLOYS IN PPS child is at risk of developmental delay, you refer it to TO IDENTIFY RED FLAGS IN CHILD DEVELOPMENT developmental screening B. Developmental Screening Done at specified ages particularly at 9, 18, and 30-month visits then yearly thereafter. A Child that is screened to be at risk should receive: o Development evaluation ▪ 🗨 To confirm a developmental diagnosis. o Medical evaluation ▪ 🗨 To investigate the etiology of the developmental condition. o Referral ▪ 🗨 To early intervention services to improve the life of a child. Figure 30. Differentiate surveillance and Screening Figure 31. Screening tools specific for autism, done in children who is 2 years old. Page 11 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 a) Genetics b) Neurology c) Societal and community systems d) Family dynamics Answer: c) Societal and community systems 3. In the Ecobiodevelopmental Framework, which process is emphasized as interacting with biological processes to determine outcomes and life trajectories? a) Genetic inheritance b) Physical exercise c) Ecology of childhood (social and physical environments) d) Parental education Answer: c) Ecology of childhood (social and physical environments) 4. According to Freud's psychosexual stages, which stage is characterized by the child developing strong attachments to the parent of the opposite gender? a) Oral Stage b) Phallic Stage c) Latent Stage d) Genital Stage Answer: b) Phallic Stage 5. In Erikson's psychosocial stages, which conflict occurs during adolescence (12-18 years)? a) Trust vs. Mistrust b) Autonomy vs. Shame and Doubt c) Identity vs. Confusion d) Intimacy vs. Isolation Answer: c) Identity vs. Confusion 6. Which of the following is NOT one of the dimensions of temperament according to the classic theory? a) Emotionality b) Sociability c) Activity level d) Intelligence XI. REFERENCES Answer: d) Intelligence Altum Septima: 016-CMED 212: Developmental Screening 7. During which stage of Piaget's Cognitive Development does and Theories of Development a child begin to think logically about concrete events? Deo Dextra: Developmental Screening & Theories of Development a) Sensorimotor Stage Nelsons Textbook of Pediatrics 22e b) Preoperational Stage c) Concrete Operational Stage Doc’s PPT d) Formal Operational Stage XII. REVIEW QUESTIONS Answer: c) Concrete Operational Stage 1. Which model primarily focuses on diagnosing and treating diseases while neglecting social and psychological aspects? 8. What is the primary focus of Kohlberg's Moral Theory? a) Biopsychosocial Model a) Cognitive Development b) Ecobiodevelopmental Framework b) Emotional Attachment c) Medical Model c) Social Interactions d) Cognitive Model d) Moral Reasoning Answer: c) Medical Model Answer: d) Moral Reasoning 2. What does the Biopsychosocial Model simultaneously 9. Which psychosocial conflict does Erikson associate with consider along with proximal systems that make up a person early childhood (3-5 years)? and their environment? Page 12 of 13  DEVELOPMETNAL SCREENING AND THEORIES DEVELOPMENT CMED 212 a) Trust vs. Mistrust b) Initiative vs. Guilt c) Autonomy vs. Shame and Doubt d) Industry vs. Inferiority Answer: b) Initiative vs. Guilt 10. In the context of developmental surveillance and screening, which is performed during every well-child visit? a) Developmental screening b) Developmental surveillance c) Medical evaluation d) Referral to early intervention services Answer: b) Developmental surveillance Page 13 of 13