DEVELOPMENT
1 Domains of development
2 Milestones in various domains
contents
3 Developmental assessment
Domains
Development is a complex process and it is easier to assess development under the
following domains:
i. Gross motor development
ii. Fine motor skill development
iii. Personal and social development and general understanding
iv. Language
v. Vision and hearing
Gross motor development .
Motor development progresses in an orderly sequence to
ultimate attainment of locomotion and more complex
motor tasks thereafter. In an infant it is assessed and
observed as follows:
Age Milestone
3mo Neck holding
5mo Rolls over
6mo Sits in tripod fashion (sitting with own support)
8mo Sitting without support
9mo Stands holding on (with support)
12mo Creeps well; walks but falls; stands without
support
15mo Walks alone; creeps upstairs
18mo Runs; explores drawers
2 yr Walks up and downstairs (2 feet/step);
jumps
3 yr Rides tricycle; alternate feet going upstairs
4 yr Hops on one foot; alternate feet going
downstairs
Fine motor development .
This primarily involves the development of fine
manipulation skills and coordination with age:
Age Milestone
4mo Bidextrous reach (reaching out for objects
with both hands)
6mo Unidextrous reach (reaching out for objects
with one hand); transfers objects
9mo Immature pincer grasp; probes with
forefinger
12mo Pincer grasp mature
15mo Imitates scribbling; tower of 2 blocks
18 mo Scribbles; tower of 3 blocks
2 yr Tower of 6 blocks; vertical and circular stroke
Tower of 9 blocks; copies circle
3 yr Copies cross; bridge with blocks
4 yr Copies triangle; gate with block
5 yr
Personal and Social Development and
General Understanding
The cognitive development and understanding is reflected by the attainment of important milestones in
this sphere:
Age Milestone
2mo Social smile (smile after being talked to)
3mo Recognizes mother; anticipates feeds
6mo Recognizes strangers, stranger anxiety
9mo Waves "bye bye"
12 mo Comes when called; plays simple ball game
15mo Jargon
18mo Copies parents in task (e.g. sweeping)
2 yr Asks for food, drink, toilet; pulls people to
show toys
3 yr Shares toys; knows full name and gender
4 yr Plays cooperatively in a group; goes to toilet
alone
5 yr Helps in household tasks, dresses and
undresses
Language
Throughout the development of language it is the receptive ability and understanding which precedes
expressive
Age. Milestone
1mo. Alerts to sound
3mo. Coos (musical vowel sounds)
4mo. Laugh loud
6mo. Monosyllables (ba, da, pa), ah-goo sounds
9mo. Bisyllables (mama, baba, dada)
12mo. 1-2 words with meaning
18mo. 8-10 word vocabulary
2 yr. 2-3 word sentences, uses pronouns" I", "me","you"
3 yr. Asks questions; knows full name and gender
4 yr. Says song or poem;tells stories .
5 yr. Asks meaning of words
Hearing and vision
The ability to see and hear is apparent even in the newborn. Thereafter maturation of visual and hearing
pathways are reflected by specific visual and auditory behaviors.
Vision The best stimulus to check visual behavior is the primary caretaker's face.
At birth: follow or fixate on a moving person or dangling ring
1mo: fixate on mother when she talks
3mo: grasping with the eye
4mo: binoculor vision well established
6mo: adjust position to follow the objest of interest
1yr: follow rapidly moving objects; later on recognises them also
Hearing Hearing, may be checked by producing sound 1.5 feet away from the ear (out of field of vision), and a
pattern of evolving maturity of hearing can be observed.
Newborns respond to sounds by startle, blink,cry, quieting or change in ongoing activity
3-4mo: moves head towards the source of sound
5-6mo: turns the head to one side and then downwards if a sound is made below the level of ears.
7 mo: localises sound above the ear
10mo: looks at the source of the sound diagonally
Developmental assessment
Developmental delay is estimated to be present in about 10% of children.
Development delay = (developmental age/chronologic age) × 100=< 75%
Prerequisites -
place should be free from distractions
Child should be in playful mood, not hungry, around mother and should be comfortable
assessment kit-
• A red ring (diameter 6-7 cm) tied to a string
• Nine red cubes
• Paper pellets
• Spoon
• Cup with handle
• A book with thick pages
• Picture book
• Red pencil, paper
• Doll and mirror
Developmental assessment
Steps
history-
i) assess physical growth and head circumference,
ii) do a physical assessment, particularly for dysmorphism, stigmata of intrauterine infections and signs hypothyroidism,
iii) screen for vision and hearing, and
iv) conduct neurological examination and examine for primitive reflexes (if required).
Significant delays on screening is an indication for a detailed formal assessment of development status. By
assessment one can assign developmental quotient (DQ) for any developmental sphere. It is calculated as:
DQ = (Average age at attainment / Observed age at attainment) *100
A DQ below 70% is taken as delay and warrants detailed evaluation.
Better assessment for children over 5 years of age as IQ tests mainly assess the cognitive/adaptive behavior
part of the development. The age at which a particular test can be applied depends on the test items. and DQ done for
overall assessment.
Developmental assessment
Steps
history-
asking parents open ended ended quetions and to elaborate on developmental concerns
Developmental “red flags” in infancy and early childhood
• No visual following by 8 weeks and poor eye contact
• Uncoordinated eye movements with head turning after 3 months
• Persistent fisting (especially with thumbs adducted across the
• palms beyond 3 months)
• No head control by 6 months
• Not sitting independently by 10 months
• Unable to walk alone at 18 months
• No pointing to show demand or interest by 14 months
• No words with meaning by 18 months
• Not joining two words by 30 months
• Features of pervasive developmental disorders (com pulsive and
• ritualistic activities, severe language delay, poorly developed
• social relationship, abnormal attachment to inanimate objects,
• inappropriate affect and tantrums, developmental delay
Developmental assessment
Interpretation
Retardation should not be diagnosed or suggest
on a single feature. Repeat examination is
desirable in any child who does not have a gross
delay. Factors such as recent illness, significant
malnutrition, emotional deprivation, slow
maturation, sensory deficits and neuromuscular
disorders should always be taken into account.
Developmental assessment
Developmental surveillence
During surveillance repeated observations on development are made by a skilled physician over time to see the rate and
pattern of development.
The physician should choose a standardized developmental screening tool that is practical and easy to use in office
setting.
Once skilled with the tool, it can be used as screening method to identify at risk children.
Commonly used developmental screening tests are
• Phatak's Baroda screening test
• Denver Developmental Screening Test (DDST)
• Trivandrum development test
• Clinical adaptive test and clinical linguistic and auditory milestone scale (CAT/CLAMS)
• Goodenough-Harris drawing test
Developmental surveillance
Developmental surveillence
Developmental assessment
Developmental assessment
Developmental assessment
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