Issues in Developmental Disabilities
Normal and Atypical
Human Growth and Development
Lecture Presenter:
Mary Pearlman, M.D.
Why Learn Development?
 Knowledge about Development is
necessary for
 Assessment
 Goal Setting
 Treatment Strategy Choices
Assessment
 Differential Diagnosis:
 Differential Diagnosis is all the possible
causes of a set of symptoms
Differential Diagnosis
 A Differential Diagnosis of Fever:
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Flu
Appendicitis
Diurnal temperature variation
Malaria
Malingering
Bladder infection
Alien possession
Just exercised
 (Partial List)
Assessment
 When presented with a symptom a
clinician has to determine which of
the many possible causative factors
are involved in the symptom in front
of them now
 Effective treatments for different
causes are often different.
Why Learn Development: Examples
 Assessment:
 Marc, a 6 year old boy is brought for
assessment of possible impulsive
behavior, not following commands, and
kissing peers. He has been held back a
year in school for problems with reading
and math. He is a behavioral problem
for everyone. He is very active
compared to age peers. He speaks in 3
word sentences. He needs supervision
to dress and can’t button up. He just
started riding a tricycle. He can copy a
circle but not a cross.
Differential Diagnosis: (partial list)
 Attention Deficit Disorder
 Conduct Disorder
 Mental Retardation
Assessment
 This copy of the Denver
Developmental Screen Exam may
help you with Marc’s Assessment.
DDST
Marc 6 year old boy
Boys Function
Mental Age (years)
3
PersonalSocial
Needs supervision
to dress
Can’t button self
Fine MotorAdaptive
Copy Circle
Not Copy Cross
3
Language
3-word sentences
No reading/letters
3
Gross Motor
Pedals tricycle
3
DDST
Assessment
 IQ = 100 x Mental Age / Chronologic
Age
 IQ = 100 x 3 yrs / 6 yrs
 IQ = 50
Assessment
 A knowledge of development allows
us to diagnose Marc as probably
having mental retardation.
 Social development is consistent with
mental age. Marc’s behavior is
similar to other 3-year-olds.
Why Learn Development?
 Knowledge of development helps with
Goal Setting
Goal Setting
 Teaching “Following Commands”
 Marc stops an activity when told “No”.
 Marc will not make his bed independently.
 Marc can spend 5 minutes learning new
material.
 He can enjoy familiar material for about ½ hour.
 Marc cannot read the clock. He knows “Day”,
“Night”, “School time”, “Lunch time”, “Bedtime”,
and “Suppertime”.
Cartoon - Real Life
Adventures
Goal Setting
 Parents want Marc to learn to do chores
and be responsible.
 They want him to learn to change his bed
because he wets his bed
 Behavior Program:
 Marc can earn a star at lunch time if he puts his
dirty PJ’s down the chute, the dirty sheets down
the chute and if he puts the new sheet on the
bed. Mom has demonstrated this skill
 Will this behavior program work?
Goal Setting
No
 Time between activity and reward too long
 Activity has too many separate parts for a
3-year-old to remember
 Activity requires fine motor skills too
advanced.
 Activity requires more strength than Marc
has
 Marc has button PJ’s. He can’t manage
buttons yet.
Cartoon
Goal Setting
 A knowledge of Development would
suggest more developmental ageappropriate responsible tasks.
 Clearing dishes from the table to the
counter top.
 Emptying small waste baskets
 Wiping the sink after he brushes his
teeth
 Putting cans in recycling.
Goal Setting
 Rewards should occur soon (5 min)
after Task Completion.
 “Thanks, Marc! You were a big help.”
 “We have our chores done. Let’s color.”
Development: Treatment Strategy
Choices
 Marc’s bedwetting is truly a problem
for the parents. They want him to
stop.
 Is this possible given Marc’s mental
age?
Rx Strategy Choices
 Development – Bedwetting
 Gesell: Elimination—Developmental
Sequences = 36 months.
 Responds to routine times
 Goes by self - during day, but announces
 May hold of too long, dancing up and down, may
accidentally wet
 Needs help with buttons
 Attempts to wipe self, not too successful
 Median age 42 months – dry at night
 This means a significant minority of children are
not toilet trained at night at 42 months.
Rx Strategy Choices
 Knowledge of Development suggests that it
may be Normal developmentally for Marc to
still wet at night.
 His chronologic age is 6-years.
 His mental + social age is 3-years.
 What are the best treatment choices?
 The parents need relief. The parents will
benefit from developmental education.
Knowledge of Development
 Knowledge of Development helps with
Treatment Strategy Choices
 Treatment can be based on:
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Environmental modification
Prevention
Positive Reinforcement
Negative Reinforcement
Punishment
Cartoon
Rx Choices
 Knowledge of Development helps with
Strategy Choices
 Environmental Modification: Yes – use
chucks, pull up big boy diapers
 Prevention: Yes – limit drinking after
suppertime. AM bath to clean up
 Positive Reinforcement: Yes – throwing away
wet chuck or diaper inappropriately.
 Negative Reinforcement: Maybe – if discards
chuck or diaper inappropriately. Has to go
back and do appropriately.
Behavior Management
 These Behavior Management
Strategies need to be used to teach
desirable behaviors in successive
approximations.
Rx Choices
 Punishment: May make things
worse –
 Child frightened more wetting, trouble
sleeping.
 Child angry and less compliant, more
distant
Cartoon - P.S.
Mueller
Why Learn Development: Summary
 Knowledge of Development is
necessary for:
 Assessment
 Goal Setting
 Treatment Strategy Choices
Don Anderson’s Note
 Understanding normal or typical
development is the primary
foundation prior to the study of
developmental disabilities and
atypical or varied course in
development.
Normal Development:
Childhood
 Developmental Lines: Definition
 An skill that can be observed and
assessed from birth to death, that
involves one functional area. The
acquisition of skills is an orderly
process, succeeding skills based on
earlier skills in that functional area.
Normal Development:
Childhood
 Examples of Developmental Lines
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Motor skills, gross and fine
Perceptual skills
Impulse Control
Cognitive Skills
Play skills
Social Relations/ Attachment
Speech and Language
Normal Development: Infancy
 Babies are born with a set of skills
 Reflexes
 Readiness to
 Orient to voice
 Orient to caretaker
 Self-management skills
Normal Development: Infancy
 Self Management Skills
 Described by T. Berry Brazelton, M.D.
who developed a neonatal
development assessment scale based
on these items.
 Sharing the results of this assessment
with caretakers gave the parents
more self confidence and
effectiveness in dealing with the
infancy period of development.
Normal Development: Infancy
 Temperament: Definition
 The set of innate tendencies, or
dispositions, that underlie and affect
each person’s interactions with
people, situations and events
Normal Development: Infancy
Temperamental Characteristics
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Activity Level
Rhythmicity
Approach –withdrawal
Adaptability
Intensity of reaction
Threshold of responsiveness
Quality of mood
Distractibility
Attention span
Normal Development: Infancy
Tasks of the Infant Period
 Tasks of the infant period
 Feeding/Elimination
 State-Regulation
 Learning about the perceptual and
sensory
 Learning early motor skills
 Attachment
 Early logic
 Language readiness and imitation skills
Normal Development: Infancy
Attachment
 Attachment
 Reciprocal interaction in the mother
child relationship in infancy.
 Research done by T. Berry Brazelton
Normal Development: Infancy
Communication
 Talking with the eyes:
 Social referencing
 Drawing adult’s attention to object of
interest
 Negation
 Emotional expression
Normal Development: Infancy
 By 4 months of age
 A mother can distinguish the meaning
of the baby’s different cries
 The baby can wait to feed, if mother
says “coming, baby”.
Normal Development: Childhood
Piaget’s Periods of Cognitive Development
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0-2yrs: Sensorimotor
2-6yrs: Preoperational
7-11yrs: Concrete operational
12yrs-adult: Formal operational
Some adults age varies: Post
operational
Normal Development: Childhood
 Play as an exemplar of Piagetian
theory
Normal Development: Childhood
 Gender Identity exploration reflects
Piagetian Cognitive Development
Normal Development: Childhood
 Language and symbol formation
 Truckness
 Suck the truck
 Bang the truck
 Roll the truck on fabric and spin the
wheels
 Watch a real truck outside and hold up
the little truck and say ”truck”
Normal Development: Childhood
 Attachment and Piaget contribute to
conscience development
Normal Development: Childhood
 Socialization at different ages
Normal Development: Childhood
 Autism and atypical developmental
course