Development and Behavior

Dr. Faten Zaidan

Factors to be Considered While Assessing Development

Table 8.4: Context of Behavioral Problems
Child Factors
Health (past and current)
Developmental status
Temperament (e.g., difficult, slow to warm up)
Coping mechanisms
Parental Factors
Misinterpretations of stage-related behaviors
Mismatch of parental expectations and characteristics of child
Mismatch of personality style between parent and child
Parental characteristics (e.g., depression, lack of interest, rejection, overprotective, coping)
Environmental Factors
Stress (e.g., marital discord, unemployment, personal loss, perceived racism)
Support (e.g., emotional, material, informational, child care)
Poverty—including poor housing, poorer education facilities, lack of access to healthy foods (food deserts), unsafe environments, toxic stress, poor access to primary care
Racism

Definition of Normal Development:

Parallel to the changes in the developing brain (i.e., cognition, language, behavior) are changes in the physical development of the body.

The History

Screening is Based on the:

• History
• Physical and developmental examination
• Interpretation and comparison to normal child at the same age

General History:

• Birth weight and duration of gestation.
• Prenatal risk factors e.g., infectious, hypertension.
• Genetic factors: mental subnormality.
• Familial pattern of development.
• Perinatal factors e.g., fetal distress.

Condition at birth.

• Postnatal development e.g., when beginning to smile. Sucking or swallowing difficulties, irritability, etc.
• Major illnesses, emotional deprivation, etc.
• The previous development: Is he showing accelerated development? or slowing of development (i.e., loss of attained functions) e.g., neurodegenerative diseases?

Developmental History:

• Assess the mother’s understanding and memory.
• Ask whether the baby shows a particular skill (e.g., smiles) and when he began to show it.

Examination of Primitive Reflexes

Examination of the primitive reflexes provides assessment of the functional integrity of the brainstem and basal ganglia, indicating the normal maturation of descending inhibitory cerebral influences. Asymmetry or persistence of the primitive reflexes may indicate focal brain or peripheral nerve lesions.

REFLEX	DESCRIPTION	AGE AT APPEARANCE	AGE AT DISAPPEARANCE
Moro	Light drop of head produces sudden extension followed by flexion of the arms and legs	Birth	3–6mo
Grasp	Placing finger in palm results in flexing of infant’s fingers	Birth	3–4mo
Rooting	Tactile stimulus at the side of the mouth causes the mouth to pursue the stimulus	Birth	3–4mo
Trunk incurvation (Gallant)	Stroking the skin along the edge of vertebrae produces curvature of the spine with concavity on the side of the stimulus	Birth	4mo
Placing	When dorsum of foot is brought into contact with the edge of a surface, infant places foot on the surface	Birth	4–6mo
Asymmetric tonic neck	With infant supine, turning of the head results in ipsilateral extension of the arm and leg with flexion of opposite extremities in a “fencing” posture	Birth	3mo
Parachute	Infant is suspended face down by the chest. When infant is moved toward a table, the arms extend as if to protect self	8–10mo	Never
Babinski	Stroking lateral aspect of sole from heel up results in dorsiflexion of the great toe and fanning of the remaining toes	Birth	12–18mo

Moro Reflex

The Moro reflex is elicited by allowing the infant’s head to gently move back suddenly (from a few inches off of the mattress onto the examiner’s hand), resulting in a startle, then abduction and upward movement of the arms followed by adduction and flexion. The legs respond with flexion.

Grasp Reflex

Rooting Reflex

The rooting reflex is elicited by touching the corner of the infant’s mouth, resulting in lowering of the lower lip on the same side with tongue movement toward the stimulus. The face also turns toward the stimulus.

Gallant Reflex

Placing Reflex

Asymmetric Tonic Neck Reflex

The asymmetric tonic neck reflex is elicited by placing the infant supine and turning the head to the side. This placement results in ipsilateral extension of the arm and the leg into a “fencing” position. The contralateral side flexes as well.

Parachute Reflex

Babinski Reflex

Sucking Reflex

The sucking reflex occurs with almost any object placed in the newborn’s mouth. The infant responds with vigorous sucking. The sucking reflex is replaced later by voluntary sucking.

Development Milestones

Here’s the table in text format:

Age	Gross Motor	Fine Motor–Adaptive	Personal-Social	Language
2 wk	Moves head side to side	—	Regards face	Alerts to bell
2 mo	Lifts shoulder while prone	Tracks light past midline	Smiles responsively	Cooing Searches for sound with eyes
4 mo	Lifts up on hands Rolls front to back If pulled to sit from supine, no head lag	Reaches for object Raking grasp	Looks at hand Begins to work toward toy	Laughs and squeals
6 mo	Sits alone Rolls back to front	Transfers object hand to hand	Feeds self Holds bottle	Babbles
9 mo	Pulls to stand Gets into sitting position	Starting to pincer grasp Bangs two blocks together	Waves bye-bye Plays pat-a-cake	Says Dada and Mama, but nonspecific Two-syllable sounds
12 mo	Walks Stoops and stands	Puts block in cup	Drinks from a cup Imitates others	Says Mama and Dada, specific Says one to two other words
15 mo	Walks backward Stoops and recovers	Scribbles Stacks two blocks	Uses spoon and fork Helps in housework	Says three to six words Follows commands
15 mo	Walks backward Stoops and recovers	Scribbles Stacks two blocks	Uses spoon and fork Helps in housework	Says three to six words Follows commands
18 mo	Runs	Stacks four blocks Kicks a ball	Removes garment “Feeds” doll	Says at least six words
2 yr	Walks up and down stairs Throws overhand	Stacks six blocks Copies line	Washes and dries hands Brushes teeth Puts on clothes with assistance	Puts two words together Points to pictures Knows body parts
3 yr	Walks steps alternating feet Broad jump	Stacks eight blocks Wiggles thumb	Uses spoon well, spilling little Puts on T-shirt	Names pictures Speech understandable to stranger 75% Says three-word sentences
4 yr	Balances well on each foot Hops on one foot	Copies O, maybe + Draws person with three parts	Brushes teeth without help Dresses without help	Names colors Understands adjectives
5 yr	Skips Heel-to-toe walks	Copies □	—	Counts Understands opposites
6 yr	Balances on each foot 6 sec	Copies △ Draws person with six parts	—	Defines words

4 Months Old

10 Months old

Following objects

• 1 month: follows to midline
• 2 months: follows past midline
• 3 months: follows 180°

Language: expressive - Speech and Language

• Coos
  • 2 months (2–4 months)
• Laughs out loud
  • 4 months
• Babbles
  • 6 months
• Mama or dada nonspecific
  • 9 months
• Mama and dada specific
  • 12 months
• Vocabulary of 10–25 words
  • 18 months
• Two-word sentences
  • 2 years (18–24 months)
• Three-word sentences
  • 3 years (2–3 years)
• Four-word sentences
  • 4 years (3–4 years)

Cubes

Blocks

• Passes cubes
  • More than 6 months
• Bangs cubes
  • 9 months
• Block in a cup
  • 12 months
• Tower three blocks
  • 15 months
• Tower four blocks
  • 18 months
• Tower six blocks
  • 24 months
• Bridge from blocks
  • 3 years
• Gate from blocks
  • 4 years
• Steps from blocks
  • 5 years

Drawing

Drawing

• Scribbles
  • 15 months
• Circle
  • 3 years
• Cross
  • 4 years
• Square
  • 4.5 years
• Triangle
  • 5 years
• Diamond
  • 6 years

Red Flags in Development as per Age

Age	Red Flags
2 months	Lack of fixation ***
4 months	Lack of visual tracking
6 months	Failure to turn to sound or voice ***
9 months	Lack of babbling consonant sounds
24 months	Failure to use single words, cannot follow simple direction, pointing instead of speaking
3 years	Failure to speak in three-word sentences ***
4 years	Cannot tell story

Cause of language developmental delay

• Hearing impairment
• Intellectual disability
• Autism
• Specific language disorders
• Dysarthria
• Dyspraxia
• Maturation delay
• Neglect

Bicycle & Scooter

• 3-wheels bicycle: 3 years old
• 2-wheels bicycle with training wheels: 4 years old
• 2-wheels bicycle without training wheels: 5 years old
• 3-wheels scooter: 4 years old
• 2-wheels scooter: 5 years old

Stairs

A) Going Up:

• 18 months old: Two feet on each step with support
• 2 years old: Two feet on each step without support
• 3 years old: One foot on each step

B) Going Down:

• 2 years old: 2 feet on each step
• 3 years old: One foot on each step without support

Behavioral Disorders Presentations

• Infantile Colic

• Temper Tantrums

• Separation Anxiety Disorder (SAD)

• Enuresis

• Abnormal Sleep Patterns