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 There are immensely complicated, mysterious, and beautiful transformation (biological, psychological and social) that take place between conception and old age
 The period from CONCEPTION TO BIRTH sets the stage for all other development that we undergo as humans
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 Genetic factors play a prominent role in determining the biological potential of a fetus.
 The process of development is a sequential unfolding of normal events (and disorders) that are genetically determined
 In about 40% of children with ADD heriditary factors are the basis
 Down syndrome (trisomy 21), Klinefelter syndrome
(XXY) and Fragile X syndrome are also genetically determined conditions
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 Sex and survival factors:
 At conception 160 M : 100 F
 At birth the ratio is aprox. 100 M : 100 F.
 The surviving males have a higher risk for some degree of brain dysfunction
 ADD ten times more frequent in males
 Gestational age, birth-weight, maternal health, and perinatal factors may predict outcome
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 The intrauterine environment can significantly affect fetal brain development, and hence all future actions (behaviors)
 Animal models used to mimic adverse intra uterine conditions in humans
 Intrauterine insults to the brain may be acute or chronic
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 Even brief periods of hypoxemic compromise can have significant effects on the fetal brain causing neuronal loss and cerebral white matter damage
 Subtle brain injury can occur, for example to a particular class of neuron, and this can have a significant effect on the function of a specific system,
(eg hearing, vision)
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 Chronic mild placental insufficiency can result in long term deficits in neuronal connectivity
 Repeated acute exposure to an inflammatory agent results in diffuse subcortical white matter damage and in some cases periventricular necrosis.
 The timing and severity of these prenatal insults determines outcomes, in terms of the severity of the damage and the regions of the brain affected.
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 Placenta mediates fetal growth and influences long-term health
 Placenta to birth-weight ratio is regarded as an indicator of the quality of placental function
 Maternal prenatal smoking and alcohol consumption may influence fetal growth by either directly or indirectly altering the function of the placenta, and hence the development of the fetus.
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Reminder of placental role:
 Exchange process via membranous exchange mechanisms
 The fetal lung
 Nutritive and excretory functions
 Protective function and Immunological barrier
 Endocrine function and protein transfer
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 Some microbes can cross the placental barrier despite its efficiency:
 Sexually transmitted diseases (treponema palidum, HIV, Neisseria Gonorrhea
 Feto-toxic infections (rubella, toxoplasmosis, cytomegalovirus, herpes simplex genitalis)
 Drugs (most antibiotics, corticosteroids, teratogenic drugs such as Roacutane and
Thalidomide
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 At birth, the infant is pre-adapted to be cared for by the mother by the presence of attachment
behaviors.
 Initial attachment behaviors (eg. crying and clinging) increase the likelihood of maternal care and assist the infant in attaching to the mother
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 The neonate possesses a number of innate simple reflexes
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Moro reflex or startle reflex: flexion of extremities in response to sudden stimulation
Palmar grasp reflex
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The rooting and sucking reflexes (both aid in feeding the infant
The Babinski reflex
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 Key : Consult table in text for schedule of motor,
vocal, and sensory development sequences of the infant
 Cognitive maturation: by age 18 to 24 months a child is capable of elementary trial-and-error reasoning.
 For example a child will attempt to place a square object into a square opening of a form box after trying to insert it into the circular and triangular opening
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 Two separate patients: Mother and Infant
 Infant status
 APGAR
 Primitive reflexes (Startle, sucking, grasp, Babinski)
 Maternal status
 Physical status
 Psychological status
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 Several theories, derived primarily from clinical experience and experiment.
 Perhaps the best known systems in use today, are:
 Freud’s psychoanalytic theory,
 Piaget’s Cognitive developmental stages
 Ericson’s Psychosexual stages
 The theories mostly identify developmental landmarks
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 There is a lawfulness to all natural development, which serves as a framework within which we can assess and understand children and adults
 Epigenesis: The development of an embryo from the successive differentiation of an originally undifferentiated structure (Epigenetic= after genes)
 Physical Epigenesis
 Behavioral Epigenesis
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 The pre-school child traverses several motor, social, and verbal/cognitive developmental zones by age six.
 Key : See schedule of age-related developmental tasks, in text. Important to have an appreciation of these milestones
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 There are many Developmental Screening-and-
Assessment (S&A) Instruments for young children ages birth through five years
 Link to S&A instruments: http://www.nectac.org/~pdfs/pubs/screening.pdf
 These instruments emphasize Psychological,
Social, Emotional and Physical Development
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 The principle psychological task of the first year of life is the formation of intimate differentiated
attachment to mother of caregiver.
 Failure of the infant to develop this specific early attachment may result in later defects in the capacity for empathy and for close warm reciprocal relationship.
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 The social smile is an early marker of the beginning development of a specific differentiated relationship, as are the preferential vocalization, visual pursuit and anticipatory gesturing of the 5-month-old infant in the presence of the mother
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Endogenous smiling develops from an innate reflex response at birth
Exogenous smiling a response to the form of a face – 8 weeks
Preferred social smile a response to mother’s face 16 weeks
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 Stranger anxiety begins at ~ 8 months
 Object relations (psychoanalytic theory)
 Response to Maternal deprivation/separation
 Play: its role and significance
 Autonomy and self awareness
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 Sociocultural factors:
 Innercity: increases risk of psyc. disorders
 ADD: twice as high in low income families
 Psychosocial, or sociocultural, retardation: deficient language, speech and cognitive skills associated with relative deficiency in adequate early stimulation (usually lower socio economic class)
 Weaning from bottle shorter in middle class
 toilet training favors lower class
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