DEVELOPMENT AND

ASSESSMENT
 DEVELOPMENT

DEFINITION
• Development refers to maturation of functions and acquisition
of various skills for optimal functioning of an individual.
 LAWS OF DEVELOPMENT

1. Development is a continuous process, starting in utero and

progressing in an orderly manner until maturity.
2. Development depends on the functional maturation of the
nervous system
3. The sequence of attainment of milestones is the same in all
children.
4. The process of development progresses in a cephalocaudal
direction.
5. Certain primitive reflexes have to be lost before relevant
milestones are attained.
6. The initial disorganized mass activity is gradually replaced by
specific functions.
DOMAINS OF DEVELOPMENT

● Gross motor development

● Fine motor skill development
● Personal and social development and general
understanding
● Language
● Vision and hearing
A) GROSS MOTOR
B) FINE MOTOR

● Development of fine manipulation skills and

coordination with eye
● Assessing components are-
○ Hand eye coordination
○ Hand to mouth coordination
○ Advanced hand skill
○ Dressing
KEY FINE MOTOR MILESTONES
SOCIAL DEVELOPMENT
L ANGUAGE MILESTONES
 DEVELOPMENTAL QUOTIENT (DQ)

DQ= Average age at attainment ×100

Observed age at attainment
● A DQ below 70% is taken as the delay that warrants detailed
evaluation.
● They give different kinds of estimates of development like an
overall score of development and subscores for gross
motor ,fine motor,visual perception,receptive
language ,expressive language etc
RED FL AG SIGNS
 DEVELOPMENTAL DELAY

Global developmental delay, intellectual disability

• Global development delay is defined as delay in acquiring
milestones in two or more of the following domains namely,
gross and fine motor, speech and language , cognition, socio-
personal and activities of daily living.
• Above 5 years of age the term intellectual disability is used
replacing the previously used term mental retardation
• Prevalence is 2.5 to 5%.
 DEVELOPMENTAL DEVIANCE AND
DISSOCIATION

• Deviance : acquisition of milestones in a sequence that is

different from usual.
Eg: Developing children may not crawl and directly start walking
from sitting and standing without support.
• Dissociation: acquisition of development milestones in various
domains at differing rates.
Eg: isolated speech delay with normal development in other
domains as in patients with congenital hearing loss.
ETIOLOGY
 MANAGEMENT

• A child with development and delay is managed by a multi

disciplinary team comprising of neurologist, psychologist,
psychiatrist etc.
• Early intervention is important to achieve maximum
developmental potential.
 AUTISM SPECTRUM DISORDER

• It is characterised by the triad of qualitative impairment of

social behaviour, communication skills and associated
stereotypic and restrictive behavioural patterns
• Onset : before 3 years
• Global prevalence: 1-2%
 ETIOPATHOGENESIS

• Unclear pathogenesis
• Abnormalities in neural connectivity and migration, dendritic
and synaptic morphology and functioning of mirror neurons
have been implicated.
• Genetic causes such as fragile X syndrome , Angelman
syndrome and phenylketonuria account for 10% cases.
 DIAGNOSIS AND MANAGEMENT

• According to DSM 5, to be labelled as ASD , a child has to fulfill a minimum

number of symptoms in two domains (social interaction, communication and
behaviour)
• Management is by behavioural intervention with limited role of
pharmacotherapy.
• Drugs used:
1. Antipsychotics (risperidone) : anxiety, aggression
2. Methylphenidate: inattention, hyperactivity
3. Alpha-2-agonists: hyperactivity
4. Melatonin: sleep-related problems
5. Iron supplements: deficiency
 ATTENTION DEFICIT HYPERACTIVITY
DISORDER (ADHD)

• Most common neurobehavioural disorder of childhood

• Onset: upto 12 years
• Clinical features:
1. Inattention
2. Hyperactivity
3. Impulsivity
 DIAGNOSIS AND MANAGEMENT

• ADHD is diagnosed clinically.

• The DSM 5 criteria require fullfilment of pre-defined criteria in 3
domains inattention, hyperactivity and impulsivity.
• The cornerstone of management is psychotherapy .
• Drugs like methylphenidate and atomoxetine are used.
 SPECIFIC LEARNING DISABILITY

• It is defined as a persisted impairment in reading

(dyslexia) ,writing (dysgraphia) and arithmetic skills
(dyscalculia) in an individual with preserved cognition, vision,
hearing and adequate opportunities.
• The DSM 5 diagnosis requires fullfilling of predefined criteria in
reading, writing and arithmetic skills.
• Management revolves around remedial education.
 TIC DISORDER AND STEREOTYPIES

• Tics are abrupt onset, fast, paroxysmal, non-rhythmic motor or vocal

manifestations.
• Onset: 4-6 years, peak : 10-12 years.
• Tourette syndrome has an onset before 18 years and persistence beyond 1
year.
• It can be associated with neurological ailments like Huntington and Wilson
disease.
• Stereotypies maybe differentiated from tics as they are rhythmic and
distractable and remains stable over a time period unlike tics.
• Management is by behavioural therapy.
• Drugs like haloperidol and clonidine may be considered.
 OTHER DEVELOPMENTAL AND
BEHAVIOURAL DISORDERS

Oppositional defiant disorder

• It is a repetitive and persistent pattern of opposing, defiant and
disobedient behaviour towards authority figures persisting for at least
6 months.
• It may result from parental interactions, environmental factors and
family history of mental health problems.
Conduct disorder
• Characters by aggressive activities that cause destruction in the
child’s environment such as home or school.
• Management consists of behavioural therapy and psychotherapy.
Juvenile delinquency
• Children with oppositional defiant behaviour or conduct disorders
who come into conflict with Juvenile justice system.
Munchausen by proxy
• Disorder in which a caregiver deliberately makes up a history of
illness in her child and harms the child to create illness.
Parasomnias
• Abnormal behavioural and motor manifestations seen in sleep, most
commonly during NREM stage
Eating disorders
• This group consists of two disorders: anorexia nervosa and Bulemia
that chiefly affect 10 to 19 year old girls with a common disturbed
body image perception.
Pica
Persistent ingestion of non nutritive substances such as plaster,
charcoal etc, for at least one month, inappropriate to the child
development level.
Temper tantrums
A child’s response to physical or emotional challenges by attention
seeking practices like yelling , biting or crying.
Breath holding spells
• These are reflex events typically initiated by a provocation that
causes anger or frustration making the child cry.
• The crying stops at full expiration and makes the child apneic ,
cyanotic or pale or even unconscious.
• Peak at 2 years and abate by 5 years.
Thumb sucking
• Peak is by 18 to 21 months of age and disappears by age 4 years.
• Persistence in older children can lead to dental malalignment.
Stuttering
• Spasmodic repetition of some syllables with pauses.
Eneuresis
• Passage of urine in the clothes beyond an age when bladder control
should be established i.e. 5 years.
• It may be secondary to diabetes or urinary tract abnormalities.
Encopresis
• Passage of stools in the clothes beyond an age when bowel control
should have been achieved usually 4 years.
THANK YOU