Tag: developmental delays

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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: 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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1.5 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.

1 see References
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1.5 Communication Development: Articulation

Articulation

The development of articulation1 follows a sequence that takes several years to complete. Some speech sounds, such as “l” “r” , “s” and “i“, are especially difficult to learn how to say, or to pronounce (see full Glossary) (Fig. 1) and some children do not master the ability to make these sounds correctly until  they are seven or eight years old. Other speech sounds (e.g., “th” as in “this” and “zh” as in “pleasure”) are developed later on, by age 8. In order to find out which speech sounds develop at which age, please look at the Speech Sound Development Chart.

Articulation

Figure 1. The illustration shows what needs to happen inside the child’s body for pronunciation or articulation to happen

Some signs of articulation difficulties include:

  • Understanding of the child’s speech by only those who know the child well, by age 4;
  • Taking a long time to speak or answer questions;
  • Showing frustration when speaking (e.g., crying);
  • Avoiding to join in or to speak in groups or any social situation and conversations (because of speech difficulties);
  • Confusing and substituting sounds after age 6 (e.g. “wabbit” for “rabbit”);
  • Missing word beginnings or endings of words (e.g. “kool” or “schoo” for “school”);
  • Missing parts of words, or syllables (see full Glossary) in longer words (e.g. “cacuta” for “calculator);
  • Saying certain speech sounds in some situations but not others (e.g. saying “s” in school but not “s” in bus): this is a serious red flag.

A child’s self-esteem2 (see full Glossary) may suffer when growing up with speech difficulties. That is because these difficulties are obvious and may draw other people’s attention to them. Children with speech delays need a little bit of extra time when asked questions, so that they can be calm as they respond to questions. This prevents the child from feeling he/she draws the attention of others. The earlier a child receives professional help to work on his or her speech difficulties, the more chances for them to succeed in their language skills.

1 see References
2. References on child self-esteem on Kids Health, available at http://kidshealth.org/parent/emotions/feelings/self_esteem.html.
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1.6 Cognitive Development: Overview

Cognitive Development

A Brief Overview1

In the Typical Cognitive Development section of this course, we described how cognitive development involves the development of thinking or evaluation and coping, or ‘adaptation’ skills. Thinking or evaluation skills, such as “thinking outside the box2 (see full Glossary),” are related to the development of intelligence (see full Glossary). Coping skills involve the ability to adapt to changes in one’s environment.  Cognitive skills also look at creativity, the ability to learn new things, retain (see full Glossary) what one has learned, and how one applies information to new situations. Cognitive development also includes pre-academic and academic skills that children need in order to succeed at school. Examples might include the ability to sit quietly for certain periods of time, the ability to listen and follow instructions and the ability to perform paper and pencil tasks.

Some children do not develop these skills at par with their peers. They may develop some of these skills much later than others —or not develop them at all. In other words, atypical cognitive development involves difficulties with both the quality and quantity of certain skills (see full Glossary):

Severe cognitive delays often effect all other areas of development. Below are some signs of cognitive delays that can be observed in all areas of development between the preschool and school age years, around ages 3 – 5 years old.

In the domain of cognitive development:

  1. Children may experience serious difficulties in learning basic concepts (e.g. colors and shapes);
  2. Children may experience serious difficulties in learning advanced concepts (e.g. counting, reading and writing);
  3. Children may experience serious difficulties in generalizing what they learn from one situation to the next;
  4. Children may experience serious difficulties in adapting to changes in their environment and to new situations.

In the domain of social/emotional development:

  1. Children may trust others too easily and readily enabling others to take advantage of them;
  2. Children may not read visual or language cues as they their attempt to socialize with others.

In the domain of motor development:

  1. Children may exhibit delays in the development of their fine motor skills;
  2. Children may exhibit delays in the development of their gross motor skills

In the domain of communication development:

  1. Children may exhibit delays in the development of their receptive language skills;
  2. Children may exhibit delays in the development of their expressive language skills;
  3. Children may exhibit delays in the development of their pragmatic skills;
  4. Children may exhibit delays in the development of their articulation skills.

In the domain of adaptive skills:

During the preschool years:

  1. Children may be delayed in becoming toilet trained, and in extreme cases, may never be toilet trained.

During the elementary school years:

  1. Children may experience difficulties bathing and cleaning themselves properly;
  2. Children may experience difficulties with dressing and undressing.

During the high school years:

  1. Male adolescents may experience difficulties with knowing how and when to shave;
  2. Female adolescents may experience difficulties knowing how to handle their menstrual cycle.

Severe cognitive delays have been linked to developmental disabilities (also known as mental retardation and developmental challenges). Developmental disabilities involve global delays and affect all areas of development, including motor, language, social and emotional, and self-help skills.

1. see References
2. Source: University of Wahington, available at: http://faculty.washington.edu/ezent/imdt.htm
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1.6 Cognitive Development: Thinking Skills

Thinking or Evaluation Skills

Children who show delays in the development of their cognitive skills1 need an evaluation. This evaluation helps caregivers and teachers understand what a child’s specific needs are, and to provide intervention as early as possible. Delays in cognitive development may result in delays in other developmental areas and are likely to affect the child’s work at school and his daily life activities as he/she grows older.

Some signs of significant cognitive delays in babies, toddlers and children are below.

Between Birth and Age 12 Months:

  • Babies may not develop object permanence; (see full Glossary)
  • Babies may not produce speech sounds and may not babble (see full Glossary);
  • Babies may not show interest in looking around their own environments;
  • Babies may not reach for objects.

At 12 Months and Older:

  • Babies and young children may not look at others;
  • Babies and toddlers may not engage in games and activities that need joint attention and joint action (see full Glossary);
  • Toddlers and young children may not explore their environments;
  • Toddlers and young children may not play appropriately with toys;
  • Toddlers and young children may not imitate others;
  • Toddlers and young children may not pretend that something is something else (for example: pretending that a spoon is a comb);

During preschool ages (2-3 year olds – 5 Year Olds)

  • Young children may no tuse imaginary play; that is, they will not pretend that they are someone else (for example, a superhero or a cat);
  • Young children may not show they understand basic language, or “qualitative” concepts (for example: tall/short, big/small);
  • Young children may not show they understand basic math, or “quantitative” concepts (for example: all, none, a little, a lot);
  • Young children may not showthey understand basic where or “spatial” concepts (for example: far/near, over/under);
  • Young children may not group or separate toys, or put them into or other objects into categories (for example: ‘only the red blocks go in a container’) (see full Glossary); (Fig. 1)

categories

Fig. 1: Organizing items into categories
  • Young children may not match (see full Glossary) pegs, toys or other objects with same colour (for young preschool children); same colour and shape (for older preschool children); same colour, shape and size (for children in kindergarten and older);
  • Young children may not put together simple puzzles (for example: large 4-8 pieces); (Fig. 2)

assemble

Fig. 2: A 9-piece puzzle that has been assembled

Young children may not recognize a pattern (see full Glossary) and continue it (for example: red blue, red blue);

  • Young children may not tell others how old they are when asked;
  • Young children may not tell others if they are a boy or a girl when asked;
  • Young children may not answer “why” questions (for example: Why do we eat? Why do we sleep?) when asked;
  • Young children may not retell basic parts of a short story when asked;
  • Young children may not count (first to five, then to 10, then to 20 by age 6);
  • Young children may not match objects using one to one correspondence (see full Glossary) (Fig. 3);

one to one correspondence

Fig. 3: Counting little bears and matching by the corresponding number
  • Young children may not imagine or talk about future events (for example: having a birthday party).

Signs of cognitive delay are not always easy to recognize in babies and even toddlers, because they are more subtle than motor delays.  It is of great importance that caregivers and others working with babies, toddlers and young children are aware—and provided with information—of their cognitive milestones.

1. see References
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1.6 Cognitive Development: Pre-Academic/Academic Skills

Pre-Academic/Academic Skills

It is very important to recognize and address the signs of delays in the pre-academic and academic (see full Glossary) areas in young children. Being aware of milestones (see full Glossary) and addressing any difficulties during the early years is likely to make a difference in the child’s learning and progress during his school years, and as he or she grows older. A child with these delays who does not receive help may be at risk when functioning within the school setting and in his/her daily activities.

Between 3 and 5 years old Some signs of pre-academic/academic delays may include the following examples.

If a young child:

  • Does not group or separate toys or other objects, or put them into  categories (see full Glossary); for example, ‘blueberries go in one plate and strawberries go in a different plate;’ (Fig. 1)

categories

Figure 1: An example of categories

  •  Does not match (see full Glossary) pegs, toys or other objects of the same colour (for young preschool children); of the same colour and shape (for older preschool children); of the same colour, shape and size (for children in Kindergarten and older);
  • Does not sort (for example: cannot tell which item goes with which: spoon goes with fork, shorts go with jacket);
  • Does not recognize a pattern and continue it (for example: red blue, red blue…); this is a very important concept in the development of mathematical skills;
  • Does not answer “why” questions (for example: Why do we eat? Why do we sleep?);
  • Does not understand “cause and effect” relations (for example: the reason we can’t play with this toy is because you broke it.);
  • Does not retell basic parts of a story;
  • Does not describe what he or she is doing;
  • Does not think about future events;
  • Does not predict “what will happen next”, (for example: Mom forgot to turn off the water. What do you think will happen?);
  • Does not count (Fig. 2: Counting toes);

counting toes

Figure 2: Counting toes

By age 6 years:

  • Does not tell “which one has more” (for example: a plate with three strawberries and a plate with five strawberries);
  • Does not perform simple addition activities (for example: If you have two pennies and I give you one more, how many will you have?);
  • Does not perform simple subtraction activities (for example: If you have three crayons and I take away one, how many will you have left?);
  • Does not recognize letters of the alphabet;
  • Does not recognize own name in print;
  • Does not read simple words;
  • Does not copy letters (from memory or an example);
  • Does not copy simple words (from memory or an example);
  • Does not copy own name (from memory or an example).

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