Author: Natasha Boskic

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1.4 ATYPICAL DEVELOPMENT

Atypical Development Overview

Atypical development

Child development exists on a continuum. The development of most children falls somewhere in the “middle” of that continuum. A child is described as developing atypically when one of two situations arises:

  • A child reaches developmental milestones earlier than other children his/her age
  • A child reaches developmental milestones later than other children his/her age

It is very important to pay attention to children whose development is just a little bit different. They are referred to as “gray area” children because for the most part, their development is typical. This is why they may not qualify to receive services in the developmental areas in which they may be struggling, especially during their school years. It is important to monitor their progress and especially watch those areas in which they may be developing typically, but lagging a bit behind their peers. Here are a few examples:

  • A child may have a lot of words in his vocabulary, but may still struggle with articulation or pragmatics.
  • A child may walk to get to where he/she needs to get, but he/she may still take much longer than other children to get to his/her destination.

It is also quite important to pay attention to children with moderate to severe delays, or who have multiple disabilities. These children are usually identified quite early in life and end up receiving a wide variety of services. Intervention should be focused on providing as much support as possible to both the child and his/her family, so that the child can  be active and participate in his/her community.

The focus of intervention for children with severe developmental delays may be different from intervention for other children. A seriously involved child may never learn how to read or walk, but with proper intervention, he/she may learn how to eat or use the toilet on his/her own. This will make a huge difference in his/her life and the lives of those who care for him/her.

After the family has received information about intervention support, parents make a decision on what types of services to accept. They should be supported in any decision they make.

see References
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1.4 Social and Emotional Development: Overview

Social and Emotional Development

A Brief Overview1

The social environment that parents provide for their children plays a very important role in the development of a child’s social and emotional skills during the early and middle childhood years.

Young children vary tremendously in their ability to deal with stressful situations. Some children seem to cope very well with stressful situations. Other children are very sensitive to stressful situations and may have trouble when reacting to them. These children may need additional support to deal with stress. The reasons some children deal well with stress and others do not are varied. Some different factors involved include genetics, a child’s earlier experiences and support received from parents, and the type of environment in which the child grows up.

It is important to learn to recognize signs of atypical development in the social and emotional domains, because these are areas where intervention can be effective to improve the social and emotional lives, and mental health of children.

Parents have a tremendous impact on the social and emotional development and overall well-being of their child. Raising parents’ awareness on this topic is very important, in light of recent findings2 pointing out how the roots of some mental health conditions, including sociopathy may be traced back to the early childhood years.

Dorothy Law Nolte’s beautiful poem summarizes the role of early experiences in children’s social and emotional development.

1. see References
2. see References
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1.4 Social and Emotional Development: Attachment

Attachment

As we saw in Module 1, Typical development, attachment is what allows a child to form healthy relationships, first with their primary caregivers, and later with others. When children form attachment bonds, they learn love, significance, safety, and security. Developing these feelings allow children to explore the world with confidence, and foster their growth and learning. Exploring the world nurtures a child’s cognitive development.

A child’s need to feel safe and loved by their primary caregivers is “hard-wired.” Love and safety ensure that children will develop secure and strong attachments to those who take care of them. When a child’s need for love and safety is ignored, children experience neglect. When a child is physically, emotionally, sexually and/or verbally abused, they may not trust their primary caregivers and feel unsafe around them. Neglected and abused children are likely to develop insecure attachment to those close to them. Children who experienced insecure attachment tend to struggle with forming healthy and loving relationships with significant others later on as adults.

The emotional and psychological well-being of a child is largely depend on the early relationships they form. This is why it is so important to support these relationships and avoid any disruptions. Disruptions in children’s early relationships have been linked to Reactive Attachment Disorder or Non-Organic Failure to Thrive (see full Glossary).

Not only are babies hard-wired to receive love and affection, they come equipped to send signals to their primary caregivers indicating this need for love and affection. Sometimes, however, these signals are weak and/or inconsistent and parents find them difficult to read. Therefore, they may not effectively respond to their babies’ needs. These difficulties in engaging with their babies, or lack of “attunement”2 may result in insecure attachment between parents and their child.

Ainsworth then listed the following conclusions about children and the different ways they attach to caregivers:

  • Insecurely attached-anxious/ambivalent: these children are less likely to be securely attached to their mothers and are less likely to trust her. Therefore it may be difficult for them to separate from their mother and explore their surroundings. They may show distress if their mother leaves and be less likely to accept her reassurance when she comes back. They are more likely to be wary of strangers.
  • Insecurely attached-anxious/avoidant: these children are also less likely to be securely attached to their mothers. They may leave their mothers’ side to explore their environment and treat their mothers and strangers in almost the same way. They are generally less likely to be distressed if their mother is away and are more likely to avoid her when she comes back.

Other researchers have done similar studies involving children and caregivers from different cultures and have come to very similar findings and conclusions!”

Vignette

Lacey’s teacher noticed that Lacey had difficulty feeling other children’s pain. When the teacher met Lacey’s parents they were emotionally detached. While waiting, Lacey’s brother cried. The parents ignored him and did not acknowledge Lacey. Lacey grew up in a home that was not emotionally responsive to her needs. By ignoring the baby they taught her that it is ok not to respond to the needs of others. Because her feelings were not acknowledged she did not learn to relate to others.

1. see References
2. see References
3. Considering Empathy by Bellous, J. (N.d.) Available at: http://www.mcmaster.ca/mjtm/3-1a.htm)
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1.4 Social and Emotional Development: Temperament

Temperament

Temperament1, or the way a person behaves, includes a whole range, or continuum of traits or characteristics. Caregivers may notice when a young child’s temperament falls on either of the extreme ends of this continuum because the child’s behavior and emotional needs may require additional management and support that is not required for his or her peers. These may be signs of atypical development. Parents will most likely need of professional help.

Children who place very few demands on their caregivers may be seen as very “easy” children. Some of them rarely cry and may not react to pain or feelings of hunger. However, it is important for caregivers to be aware that it is atypical not to react to pain or hunger, and these are not signs of an easy temperament.  Instead, these may be red flags that something in the baby’s or child’s development may require immediate professional attention. A first step is usually a referral to a pediatrician, who will start a screening process.

Some characteristics of children who are mistakenly thought to have an easy temperament include:

  • the child does not appear to feel pain (may not react to an immunization shot);
  • the child does not cry when hungry;
  • the child is not bothered by being left alone for significant amounts of time;
  • the child may oversleep.

Children whose temperament falls on the other end of the continuum may be described as being “overly difficult”. Children with overly difficult temperaments need help and should not be left to “overcome” this temperament on their own. Some characteristics of children considered as overly “difficult” include:

  • the child may cry at the slightest sign of discomfort;
  • the child may not enjoy being held or cuddled;
  • the child may not establish eye contact with others;
  • the child may be very difficult to feed;
  • the child may not have regular sleep habits and/or may continue to wake up several times during the night past the age of six months.

Most children go through “easy” or “difficult” stages.  However, if these characteristics are present most of the time, these are reasons for parents and caregivers to be concerned and seek for professional advice.

1 see References
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1.4 Social and Emotional Development: Social Skills

Social Skills

Atypical social skills1 refer to those behaviours that indicate that children are having difficulty relating to others and that may place them or others at risk in terms of safety. Children who display atypical behaviors and/or symptoms in the development of their social skills should be referred to the appropriate specialists as early as possible. Atypical social skills can be indicators of serious developmental difficulties in childhood, for example, children who hurt pets and other animals. These actions are not the same as “acting out” or when children are “going through a phase” as can sometimes happen when major changes at home happen, like death in the family or parents’ divorces. For children who consistently have these kinds of difficulties, it is recommended  that parents pay attention to them and find professional help, rather than wait for children “outgrow” these behaviours.

Some social indicators of atypical social behaviours include:

  • A child showing little or no affect since the very early stages

Some indicators that appear in the preschool years and onwards:

  • Always using the same tone (“monotone”) when speaking;
  • Destroying  toys and other objects and property;
  • Being physically aggressive towards other children and adults;
  • Being verbally aggressive towards others;
  • Hurting animals;
  • Avoiding eye contact to caregivers, friends and strangers;
  • Acting scared or panicking when someone moves quickly;
  • Being overly clingy to others at all times;
  • Showing same level of affection to caregivers and strangers;
  • Lying most of the time;
  • Running away from home or school.
1 see References
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1.4 Social and Emotional Development: Emotional Skills

Emotional Skills

Children with atypical emotional development1 have difficulties when they deal with feelings and emotions. Understanding and sharing feelings and emotions is very hard for these children. Just as with social skills, difficulties with emotional development are usually indicators of serious developmental difficulties.  Children with atypical emotional development do not “grow out” of their difficulties. They may be at risk of injuring themselves or others. Children with special needs in this area require immediate attention and should be referred to the appropriate specialists as early as possible, rather than waiting for children “outgrow” these difficulties.

Some emotional indicators of atypical social behaviours include:

  • A child showing little or no affect since the very early stages

Some indicators that appear in the preschool years and onwards:

  • Showing low or no energy;
  • Changing moods very easily; e.g., from happy to mad or to sad for no apparent reason;
  • Being very difficult to comfort or calm when upset;
  • Being unable to calm him or herself down, or self-soothe;
  • Having difficulties with adapting to different situations, with little or no self-regulation;
  • Avoiding eye contact with caregivers, friends and strangers;
  • Acting scared or panicking when someone moves quickly;
  • Being overly clingy to others at all times;
  • Showing same level of affection to caregivers and strangers;
  • Lying most of the time;
  • Hurting others;
  • Hurting self;
  • Being withdrawn and/or seeming overly shy;
  • Crying or laughing often for no obvious reason;
  • Over eating or under eating on a daily basis;
  • Eating non-food items, like toys or pebbles;
  • Sleeping too much or very little;
  • Difficulties falling asleep.

Some indicators that appear from early school years and onwards:

  • Having intense temper tantrums almost on a daily basis;
  • Engaging in sexually inappropriate behavior, like frequently touching and rubbing private parts (theirs or others);
  • Continuing to wet the bed or having toileting accidents;
  • Having difficulty paying attention and concentrating;
  • Running away from home or school;
  • Being afraid of common objects or of participating in daily activities (e.g. going to the bathroom, using rulers, scissors, etc.).
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1.4 Social and Emotional Development: Influence of Development In Early Years

How Development in Early Years Influences Development in the Elementary Years

Atypical early child development in the social and/or emotional arenas1 is likely to be also present as the child grows older. If not effectively addressed, social and emotional difficulties will turn into more serious behaviors. Atypical behaviors may signal caregivers about issues that need immediate attention and that are not part of a phase the child will “come out of ” on his or her own.

  • Some of the concerns about atypical social and emotional behaviours evolving into serious issues in the middle/adolescent school years include: A child not growing emotionally at par with other children his age, or “stunted emotional growth”;
  • A child showing cruelty to others and/or to animals;
  • A child having extremely low self-esteem;
  • A child being dependent on others to feel good about self;
  • A child at higher risk for suicide attempts;
  • A child being  unsafe about personal and intimate relationships (i.e., promiscuity);
  • A child engaging in risky, unsafe and/or criminal behaviors, including drug and alcohol use; truancy, and/or dropping out of school.

Children who continue to display atypical social and emotional skills beyond the early childhood years may end up being diagnosed with oppositional defiant disorder or conduct disorder.

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1.5 Communication Development: Overview

Communication Development

A Brief Overview1

Being aware of language and communication milestones is important for parents and other caregivers.  We often hear statements like the ones listed below from parents whose children are not speaking “like other children”, or from professionals, including family physicians:

  • “My two year-old has yet to utter her first words, but since her pediatrician is not concerned, I guess I should not think about this too much.
  • My three year-old only uses one-word phrases, but so did his father. I guess this runs in my husband’s family and I should not be worried.
  • Leave your child alone. She will talk when she is good and ready. You are ‘making a mountain out of a mole hill’ (exaggerating).”

Nevertheless, the speech and language patterns of these children seem to be different than those of others their age. These differences show both in the way they talk, or the quality of their expression, and in quantity, or how many words they know and can put together into sentences.

It may be that some physicians are not aware of the early signs of speech and language delay in young children. They may want to avoid worry for parents so they reassure parents that their children will develop language at their own pace.

It is also true that some children talk earlier than others. These children usually fall within the typical range of speech and language development. At the same time, a parent’s concerns about their child’s speech and language development are always valid and need to be heard.  Parents need to consult with a public health nurse or a speech and language pathologist.

Signs of severe delay include:

  • Not talking at three years of age;
  • Speaking in only one word phrases at five years of age;
  • Not speaking clearly (e.g., having severe speech difficulties at seven years of age).

Resources:

Click here for a list of different speech, language and communication disorders.

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1.5 Communication Development: Expressive Language

Expressive Language

The Typical Language section of this course describes expressive language1 as a tool we use to get a message across to someone. It can be oral, like when we speak, or the use of signs or ‘non-verbal’ language (see full Glossary), like when we wave “bye-bye.”  Children develop their expressive language gradually and sequentially. Some children have a hard time learning how to use gestures, signs and words to communicate. These may be signs of expressive language delay. It is important to recognize them in order to address these delays as early as possible.

Some “linguistic” signs of delays in the area of expressive language include:

  • No babbling by  age 8 months;
  • No spoken words by 18 months;
  • Speaking in one-word phrases after age two years  (e.g.: “ball” for “play ball”);
  • Mostly using baby language after age four years;
  • Repeating what they hear over and over after age three years, or ‘echolalia’ (see full Glossary);
  • Talking to self most of the time after age three years;
  • Not taking turns when speaking, as if speaking in ‘circles’, after age three years;
  • Having difficulty stating their wants and needs after age four years;
  • Giving mostly one-word answers to open-ended questions (see full Glossary) like “what did you play at the party?” by age six years;
  • Using one word to name many things, or ‘over-generalizing’ (see full Glossary) (for example, calling most four wheeled vehicles a car).

Some “non-verbal” and “behavioral” signs of expressive language delay at 12 months may include:

  • Little or no eye contact;
  • No pointing to items or objects;
  • Little or no turn taking skills (see full Glossary);
  • Little or no joint attention (see full Glossary);
  • Little or no joint action (see full Glossary);
  • Throwing temper tantrums, or hitting (when not being able to get their point across to others);
  • Becoming easily frustrated when trying to communicate with others (e.g., crying, using a loud voice);
  • Not wanting to participate in activities with others;
  • Seldom starting a conversation with others.

As described in the Typical and Atypical Cognitive sections in this course, language and cognitive development are closely related. This is why it is so important to address expressive language delays in a child as early as possible.

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1.5 Communication Development: Receptive Language

Receptive Language

The Typical Language section of this course describes receptive language1 as the ability to understand and process language. It usually develops earlier than expressive language. The development of expressive language depends on the development of receptive language.

As part of our communication with others, receptive language is a large part of our life. Therefore, a delay in the development of receptive language skills will very likely influence the development of expressive language, as well as other areas of development.

Signs indicators of receptive language delay that appear by 12 months may include:

  • Not imitating others’ sounds or behaviors;
  • Not responding to name being called;
  • Appearing not to listen.

Some indicators that appear by age three years:

  • Appearing non-compliant (e.g. not following directions);
  • Showing delays in learning how to speak, or in developing expressive language skills.

Some indicators that appear by age five years:

  • Asking others to repeat themselves;
  • Finding it difficult to answer questions.

Some indicators that appear by age seven years:

  • Finding it difficult to make sense, or ‘process’ information (see full Glossary);
  • Not wanting to join in activities with others;
  • Having difficulty understanding stories.

Some indicators that appear by age nine years:

  • Having difficulties reading sentences.
1 see References

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